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"Being the owner of three successful clinics in the field of acupuncture, I owe my gratitude to FCIM. The learning in FCIM established my solid foundation in my clinic" more

Alumni Survey
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Alumni Survey

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General Information
* First Name:
* Last Name:
Social Security Number:
Address:
City, State, Zip:
Personal Email:
Years of NCOM/FCIM Attendance:	From To
Your Award From NCOM/FCIM:

Degrees Earned at Other Insititutions

Institution #1
Institution
Major, Degree Earned	,
Location
Year
Institution #2
Institution
Major, Degree Earned	,
Location
Year
Institution #3
Institution
Major, Degree Earned	,
Location
Year
Institution #4
Institution
Major, Degree Earned	,
Location
Year

Acupuncture License Information

FL License Number:

Year Issued:

Is Your License Active?

YesNo

Was the process of obtaining your license a smooth one?

YesNo

If not, Please Explain:

Are you Currently Licensed in any Other States?

YesNo

If Yes, List Below

License #	State	Year Issued

Employment/Practice Information
Are You or Were You in Private Practice?
YesNo
If Yes, Enter Practice Information
Practice Name:
Practice Address:
Practice City, State, Zip	,
Business Phone:
Business Email:
Practice Web Site:
Year Practice Begin:
Are You Still in Practice?	YesNo
If Ended, Year Prictice Ended:
Full TimePart Time
Rate the Overall Success of Your Private Practice:
If You are not Currently Working as a Full Time practitioner, Please Fill Out the Following:
If You are Unemployed, Leave the Inforamtion Below Blank.
Employer Name:
Address:
City, State, Zip:	,
Job Title:

School Experience Feedback
If You Currently Work as a practitioner (or Have Worked as a practitioner) Full or Part Time, Which Parts of the Curriculum or Which Particular Courses Have Been Most Useful to You?
Acupuncture:
Herbal Medicine:
Western Medical Science Courses:
Business Courses:

Give Your Overall Rating of the College Program:
Which Parts of the Program or Which Courses Were Not Useful or to be Improved or Expanded?

Other Comments, Suggestions and/or Career Plans:

Do You Feel Comfortable Recommending the College to Prospective Students?
YesNo
If No, Why Not?

Thank You for Helping the College Improve Its Courses and Programs.
We Appreciate Your Feedback.

Would You Like to See an Active Alumini Association Formed?

YesNo

Would You Like to Receive the College's Newsletter and Information About Alumini Association Acitivities?

YesNo