Academy of Diagnostic & Osteopathic Medicine

Home
Alumni
Careers
- Career Application
Mission and Vision
About
Our Team
Program
Admission
Application
Financial
Portal
Open House
Research
Contact
Blog

Financial Readiness Form

Applicant Information

Today's Date*

Month

Day

Year

First name*

Last name*

Birthday*

Month

Day

Year

Home Address*

Phone*

Email*

Section 1: Financial Preparedness

Are you currently employed?*

Yes

If yes, provide the details:

Employer Name:

Position:

Monthly Income (Net): (If no income put 0)*

Do you have access to savings or other funds to support your tuition and living expenses during the program?*

Yes

If yes, provide an approximate amount: $___________

Will you be living at home?*

Yes

Will you require financial aid or external funding to attend ADOM Academy?*

Yes

Section 2: Tuition Payment Plan

How do you plan to cover your tuition costs? (Check all that apply)*

Personal Savings

Family Support

Employer Sponsorship

Loan or Line of Credit

Scholarship or Grant

ADOM Payment Plan

Other

Would you like to receive more information about ADOM's payment plan options?*

Yes

Section 3: Living Expenses During Training

Do you anticipate needing additional funds for living expenses while attending the program?*

Yes

If yes, how do you plan to cover these costs?

Do you anticipate any challenges in balancing your financial obligations during the program?*

Yes

If yes, please describe briefly:

Section 4: Emergency Preparedness

Do you have an emergency fund or financial safety net in case unexpected expenses arise during your training?*

Yes

Acknowledgement & Signature*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Acknowledgement: I acknowledge that my responses in this self-assessment form are accurate and truthful. I understand that the institution reserves the right to deny admission if, based on the results of this self-assessment, it is determined that I may face challenges in adapting to the distance education mode of delivery.