Bastyr University is very pleased that you have demonstrated an interest in our post-baccalaureate program in nutrition.

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1 Dear Prospective Student: Bastyr University is very pleased that you have demonstrated an interest in our post-baccalaureate program in nutrition. We are currently accepting applications for entry into the program in the fall quarter of To apply, please submit the following: Application forms with all sections completed Prerequisite outline listing when and where you have taken (or plan to take) the courses necessary to meet the requirements Completed narrative essay A current resume Official transcripts mailed directly from all schools or universities previously attended. (International students, please follow directions on the international student policy form.) A $75 non-refundable application fee, made payable to Bastyr University in U.S. funds (check or money order only). No letters of recommendation required If you have additional questions or need further assistance, please do not hesitate to contact the office of admissions at or mastersadvise@bastyr.edu. Again, we appreciate your interest in the post baccalaureate program in nutrition and look forward to considering you for the incoming class of Sincerely, Lauren Schoen Associate Director of Admissions

2 14500 Juanita Drive NE Kenmore, Washington Tel. (425) Fax (425) Please type or print. Fall 2014 UNIVERSITY APPLICATION Student ID (Office Use Only) Date Birthdate (M/D/Y) SS# Last 4 digits Male XXX-XX- Female Last Name First Middle Former Name(s) Mailing address Address City State Zip Permanent address (if different) Phone ( ) Address City State Zip Degree programs (Check one program only.) Doctor of Naturopathic Medicine First Year/New Student Advanced Standing/Transfer (add l $75 evaluation fee req d) Post-Baccalaureate (preparatory) Doctor of Acupuncture & Oriental Medicine Master of Arts in Counseling Psychology Master of Science Acupuncture Combined Bachelor/Master in Acupuncture Acupuncture & Oriental Medicine Combined Bachelor/Master in Acupuncture & Oriental Medicine Graduate Level Transfer (add l $75 evaluation fee req d) Master of Science continued Ayurvedic Sciences Midwifery Combined Bachelor/Master in Midwifery Nutrition Post-Baccalaureate (preparatory) Bachelor of Science with Major in: Exercise Science & Wellness Health Psychology Herbal Sciences Integrated Human Biology Nutrition Home phone ( ) Cell phone ( ) Please attach photograph here. ( Required for international students, optional for others) For Office Use Only Have you previously applied to Bastyr University? Yes No If Yes Year: Program Are you currently enrolled? Yes No Emergency contact: Name Address Daytime phone U.S. Citizen Yes No Perm resident # A- Birthplace Visa type Country of Citizenship Relationship Are you a veteran or current member of the US armed services? Yes No Describe yourself by checking one: American Indian/Alaskan Native Black/African American White/Caucasian Asian American /Pacific Islander Hispanic Other List all universities and colleges in order of attendance. If still enrolled, indicate leaving date. (If more than six, please attach separate sheet.) Institution/City/State Dates Attended mo/yr to mo/yr Degrees earned Major Year Last high school attended (transcript NOT required) City State (Please complete application on other side.)

3 page 2 Have you ever been licensed as a health care provider? Yes No If yes, please describe on separate sheet. Has disciplinary action in writing, or of any sort, ever been taken against you by a health care institution, professional association or licensing/certification board? Yes No If yes, please attach explanation on separate sheet. Are there any complaints currently pending against you before any of the above bodies? Yes No If yes, please attach explanation on separate sheet. Have you ever had any malpractice actions filed against you? Yes No If yes, please attach explanation on separate sheet. Have you ever been convicted of a felony? Yes No If yes, please attach explanation on separate sheet. Have you ever been put on probation, suspended, terminated or asked to resign by a graduate or internship training program, practicum site or employer? Yes No If yes, please attach explanation on separate sheet. Note: Students enrolled in degree programs that include clinical training will be subject to a criminal history background check before entering the clinical portion of their program. Certain convictions may limit or block clinical participation. List two persons (three required for midwifery applications), not friends or relatives, who will be sending letters of recommendation (professional colleagues, professors, advisors, employers). (Note: Undergraduate applicants to BS/MSAOM, BS/MSMW and all graduate applicants are required to submit letters.) Name Name Name (Third required for midwifery applicants only) If you have consulted a member of the Bastyr University staff or faculty regarding your admission, please list contact names here: What are the different ways you heard about Bastyr University? Check all that apply: Bastyr University website friend health care provider _ workshop/event direct mail/flyer newspaper insert ad specify publication(s) other website-please specify other Please list other programs/colleges/universities to which you are applying: How do you plan to finance your education (List amounts or percentages) Financial aid programs Family Savings Work Other (specify) Do you plan to apply for financial aid? Yes No My official transcripts and letters of recommendation (if required) are being forwarded directly to the Bastyr University office of admissions. I certify that the information in this application is complete and correct to the best of my knowledge. I have enclosed my non-refundable application fee. I am aware that deliberate falsification of any admissions information or documents is grounds for rejection or dismissal from Bastyr University. Signature Date Bastyr University is an equal opportunity institution. We do not discriminate in matters of employment or participation in programs, services or benefits on the basis of gender, race, creed, color, religion, national origin, age, sexual orientation, gender identification, individuals with disabilities or veterans status. Our programs, services and facilities are accessible to individuals with disabilities. Please contact the University in advance if you require special accommodation due to a disability. Have you: (Please check.) Completed and signed this application form? Enclosed a check for the $75 (grad & combined Bachelor/Master)/$60 (undergrad) application fee? Requested official transcripts be sent from institutions listed in your application? Attached current resume? Attached completed essay? Listed names of persons who will write recommendations for you? (See above.) Requested financial aid forms directly from the Bastyr University financial aid office Mail materials to: Bastyr University Admissions Office Juanita Drive NE Kenmore, WA

4 NUTRITION POST- BACCALAUREATE PROGRAM Juanita Drive NE Kenmore, Washington Tel. (425) Fax (425) program application Name: (Last, First, Middle) Address: In addition to the University application and the submission of official transcripts (those sent directly from the college or university), please complete the narrative essay information listed below and the prerequisite information on the back of this program application. Narrative Questions On a separate page(s), please address the following questions. Please type your responses. 1. Why are you choosing the post-baccalaureate program to complete your MSN prerequisites? 2. Which MSN track (Research, DPD of CHP) do you plan to pursue? 3. The graduate nutrition programs at Bastyr University involve rigorous academic effort. Please discuss any personal or professional accomplishments that demonstrate your ability to perform at such a level. Application continued on other side

5 NUTRITION POST- BACCALAUREATE PROGRAM program PREREQUISITES Please list the courses you have taken that you believe meet the prerequisites. Failure to complete this portion will delay the processing of your application. If you have not completed all of the prerequisites, please indicate when and where you plan to take those courses. Remember that prerequisite courses must be completed prior to matriculation. No credit is given for prerequisite course work earning a C- or lower. Related lecture/lab courses should be listed on the same line. NOTE: If you are conditionally accepted based upon completing all prerequisite courses, it is your responsibility to assure that a final, official transcript is sent to us before you may begin classes at Bastyr. Prerequisite Course Title & Number Grade College or University Term/Yr.* College algebra General chemistry I w/lab** General chemistry II w/lab General biology I w/lab Covering cellular bio & genetics * Include anticipated completion date if you are currently enrolled in this course(s). ** If you plan to take general chemistry I & II during the summer at Bastyr please note you must have a passing grade in a college level introduction to chemistry course to enter gen chem I. Please list that course here: