Applicant Name: SANTAY_PISHAROD | Document 1: Education Disclosure Instructions: Step 1: Complete the information below by identifying the school(s) where you completed your education and supervised clinical internship. Include the date that you forwarded Document 4to your school(s). { Name of School or Institution: paieeas coal Phone: Program Title /Name: € 14 URVE 6500, FREMONT RivD.| a Eines LOTMA) Suite 702, FREemont, |AYYRVEDA WELLNESS ACADEMY CA- 4u538 PRACTITIONER Level for which the Program | Date of Attendan Date Document 4 qualified you to apply for: 5 sent to school: Beginning date: 2 ntay 2012 we) (_ ) Ayurvedic Health Counselor 23) Taly 2015 Graduation date: J7"% maych | (VJ Ayurvedic Practitioner 2013 | Name of School or Institution: | Address and Phone: Program Title /Name: Level for which the Program | Date of Attendance: Date Document + | qualified you to apply for: | sent to scho Beginning date: (_ ) Ayurvedic Health Counselor | Graduation date: (_ ) Ayurvedic Practitioner Name of School or Institution: | Address and Phone: Program Title Name: Level for which the Program | Date of Attendance: Date Document 4 qualified you to apply for: sent to school: Beginning date: (_ ) Ayurvedic Health Counselor ‘ Graduation date: (_) Ayurvedic Practitioner Tfmore schools attended, please add pages as needed. Step 2: You will need to complete the top portion and send a copy of Document 4: Request for ‘Transcript or Education/Experience Confirmation (if required by your qualifying method) to each school where you completed study. 8605 santa Monica lve #46789, Los Angeles, cA 90069-4109 |wiouayurendaNANArg| emallus at ino@ayurdaNAMArg