Independent professional schools were a significant part of higher education in the United States until the rise of universities at the beginning of the 20th century. In the 21st century, the overwhelming majority of professional schools are indeed affiliated with universities; however there are a growing number of professional schools in variety of fields that are independent. The institutional perspective from organizational theory suggests these schools, like all organizations, must be creating and maintaining legitimacy in order to survive. This multiple case study explores how independent professional schools of acupuncture and Oriental medicine (AOM) demonstrate legitimacy over time. Analysis was focused on temporal patterns, correlations, and interdependencies between and/or among particular legitimizing activities within institutions, and global patterns of legitimizing activities across different institutions. Data were analyzed with specific reference to the possibility that there are multiple alternative paths to legitimacy outside of isomorphism with educational myths and structures. Findings included identification of higher education, health care, context, the profession, and business as the five arenas in which AOM schools signal their legitimacy, as well as general patterns of signaling to these arenas across all institutions over the past twenty years. Signals in each arena ebb and flow between relatively narrow limits, and it is not possible for schools to increase their signals in all areas simultaneously. Over time, the business and academic signals are generally increasing, contextual and professional signals decreasing, and health care remains fairly stable. This research marks an initial effort bring scholarly awareness both to schools of acupuncture and Oriental medicine to independent professional schools as a group. It offers support for the idea that there are multiple avenues for demonstrating legitimacy, and suggests a model for the arenas in which legitimacy operates for independent professional schools. In addition, this research articulated the concept of "multi-liminality" as both a characteristic of independent professional schools and an important feature for future research. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]