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Personal Information

Personal Information
U.S. or Canada only
Country of Origin
U.S. Residence Information
Additional Information
Your response to the following two questions about race and ethnicity is voluntary and will not affect your admission. Life Chiropractic College West does not discriminate by race, color, national or ethnic origin, religion, age, gender, sexual orientation, or disability in admissions, education, employment, financial aid, or any other College-administered programs.
Enrollment Information
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Address Information

Permanent Address
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Alternate Address
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High School

High School
Self-Reported Test Scores
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AP Classes
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University Details
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FERPA Information

I authorize Life Chiropractic College West to release my information to each of the organization(s) or person(s) below.
Please note: FERPA approval for release to the applicant is granted by filling out fax and email fields on the Addresses tab of this application.
The information released may include but is not limited to, my Directory, Non-Directory, and relevant financial records (including Federal Aid). I am waiving my rights of non-disclosure to each of the organizations or persons below. Life Chiropractic College West is not responsible for errors caused by my instructions, including information seen by unintended people. This form will be effective until I submit a completed FERPA Rescind Form, canceling the release of my information to specified parties.
Life Chiropractic College West adheres to the Family Educational Rights & Privacy Act (FERPA). This act governs student and institutional rights and responsibilities for student privacy. It covers what information about your educational records cannot be released to others without your written or authorized electronic consent.
The signature and submission of this application constitute an agreement to FERPA policies.Click here to enter text
FERPA Contact
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For information release over the phone only

Referred By

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Admission Signature

Privacy Policy Waiver
In compliance with the Family Rights and Privacy Act of 1974, Life Chiropractic College West holds all records for applicants and students in the strictest confidence. Therefore, the admissions office of Life Chiropractic College West will only discuss or correspond regarding your academic records directly with you or person or persons named on your FERPA Waiver.
Nondiscrimination Policy
Life Chiropractic College West, in accordance with applicable federal and state law and College policy, prohibits discrimination, including harassment, on the basis of race, color, religion, national or ethnic origin, gender, sexual orientation, disability, or age in any of its programs or activities of education and employment. Further, the College does not tolerate acts of coercion, intimidation or retaliation against any individual for the purpose of interfering with any right or privilege secured under the law. The College's Complaint Resolution Officer (CRO) and designated Title IX/VI and 504/ADA Coordinator, Dr. Anatole Bogatski, responds to questions about prohibited forms of discrimination or will refer you to a more appropriate campus resource. The CRO is located in Room 102-C, and he can be reached at (510) 780-4500 x4545 or

Council on Chiropractic Education Disclosure
Life Chiropractic College West desires to see that all prospective students, as well as our enrolled students, are fully aware of the requirements for licensure and/or registration throughout the world. To this end, we strongly encourage anyone with questions about licensure or registration to visit the following websites: Federation of Chiropractic Licensing Boards (FCLB) World Federation of Chiropractic (WFC) Graduates of Life West are eligible for licensure in all fifty states and the District of Columbia of the United States. It is possible, however, for a student to be admitted to Life West and not meet the requirements of a state which requires that an applicant for licensure complete a bachelor’s degree before beginning his or her chiropractic education Further, we want our prospective and enrolled students to be aware that legislation and regulations affecting the practice of chiropractic, including licensure, changes from time to time. Therefore, we encourage you to remain in dialogue with jurisdictions in which you have an interest to practice, to be certain that you are prepared for licensure/registration in each. If it is your intention to practice outside of California, you are strongly encouraged to investigate the proper licensing and/or registration requirements of such state, jurisdiction or country to ensure your eligibility upon graduation. Graduates of Life West are also eligible to be licensed in all of the Canadian provinces and in many nations around the world. Many nations also have specific residency or citizenship requirements for licensure/registration. In some jurisdictions your pre-professional education and your professional education may qualify you for registration but, due to residence, language or citizenship requirements, you may not be eligible to practice.

Payment Information

$45 Application Fee