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Online Student Enrollment Application

Name :
Address :
City :
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Province :
Zip :
Country :
Phone :
Cell :
E-mail :
Date of Birth :
Place of Employment :
Work Phone :
Marital Status :
Sex :
If married, Spouse's name :
Your Objectives :
Educational Background :
Experience :
Professional Licenses / Certificates Held :
Books, Articles and/or Columns you have written (please explain) :
Military Experience/Volunteer Work :
How did you hear about KCNH?
Choose one of the four options below.
(1) Evaluation for: Degree Program(check only one)

(2) Evaluation for: 30 Hour Diploma Program (check only one)

(3) Evaluation for: 12 Hour Certificate Program (check only one)
(4) Evaluation for: School of Natural Animal Health Program* (check only one)
*Tuition is higher than the standard tuition because of the excessive cost of textbooks.
Please evaluate for Life Experience
Transcripts Attached
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