Clean Needle Technique Course

Application Instructions

1. Fill out all sections on pages 1 and 2 of the application form, and sign where indicated (at the bottom of pages 1 and 2). INCOMPLETE OR ILLEGIBLE APPLICATIONS WILL BE RETURNED.
2. Social Security Number: If you are reluctant to place your social security number on the application form, you must make sure that you have included your birth date. This information is used as a means of identifying applicants to licensing and/or certification boards such as the NCCAOM.

3. Please list a first and second choice class date.
4. CURRENTLY ENROLLED ACUPUNCTURE STUDENTS: Please make sure your application is signed by your program's appropriate authorized officer (see Eligibility Requirements, #1, on page 2 of the application form).

5. Cost: $135 in U.S. dollars if postmarked by the application deadline.

6. Late applications: CCAOM will accept late applications sent with a $25.00 late application fee on a space available basis. No application received less than five days before the course date will be accepted.

7. Acceptable forms of payment:
   • U.S. check or money order in U.S. dollars made payable to CCAOM
   • Certified bank check in U.S. dollars made payable to CCAOM
   • Mastercard or Visa (please note that if the use of your credit card is declined by our bank, your application will be returned)

8. Language: On page 1 of the application form, please indicate the language in which you would like to take the written examination. Please refer to the "Language Requirement" section under the Policies and Procedures portion of this application packet.

9. 9. Send (or fax) completed applications with payment to: CCAOM CNT Course, 600 Wyndhurst Avenue, Suite 112, Baltimore, MD 21210. (Our fax number: 410-464-6042.) If you fax your application to us, please call 410-464-6040 to make sure that your application was received; not all faxes are successfully transmitted. You can also e-mail applications to us as a scanned attachment to ccaomcnt@comcast.net. Please make sure that you have signed and dated the bottom of both pages of the application form.
10. If you would like the CCAOM to submit verification on your behalf to the NCCAOM, a state board, or another entity, please mail the following to our office:
    • YOUR NAME, ADDRESS and TELEPHONE NUMBER
    • APPROXIMATE DATE on which you took the CCAOM CNT course
    • NAME and ADDRESS of the board, agency, or other entity that you would like this information sent to
    • $10.00 per request