Athletic Therapy Certificate Program Fall 2019 Entry Application Form

Please complete this form to apply for the Athletic Therapy Certificate program.

Applications and References must be received by February 1, 2019.

Your student account will be charged a $75.00 application fee on February 15, 2019.

Should you encounter difficulties with this form, please contact us via email at ugkhs@yorku.ca

Page 1 of 5 - Contact Information

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CONTACT INFORMATION
Applicant Name * First Last
Student Number *

Please enter your student number here.
York U Email *

Please enter your York U email address.
York U Email - Please re-enter *
Alternate Email *
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone - ### - ### ####

Athletic Therapy Certificate Program Fall 2019 Entry Application Form

Athletic Therapy Certificate Program Fall 2019 Entry Application Form

Page 1 of 5 - Contact Information

CONTACT INFORMATION