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Enrollment Application
Ready to Embark on Your Massage Therapy Journey?
Answer the following questions to get started!
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Email
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Your email
Name
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First and last name
Your answer
Best phone number to reach you & leave a message
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Your answer
Is this a mobile phone?
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No
Required
May we text you?
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No
Address
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Are you 18 years of age or older?
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Date of Birth
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Preferred Pronoun(s)
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Are you a U.S. citizen
Yes
No
Current Employment Status
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Current occupation
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Current employer
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How did you hear about us? If you were referred, please share by whom.
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Preferred Start Date for the Professional Massage Therapy Training Program
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Highest Level of Education Received
Your answer
Please provide a brief assessment of your academic strengths and challenges
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This program requires physical participation and some strength. Do you have any limitations* (physical, emotional, mental) that would prohibit you from 100% participation?
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What are ways that we can support your learning needs?
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Have you ever had a professional massage?
If yes, tell us about it
Your answer
Please describe what it is about becoming a Licensed Massage Therapist that interests you.
Your answer
Additionally, tell us why this is the obvious next step for you.
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What qualities do you possess that you feel would be an asset to you as a Licensed Massage Therapist?
Your answer
Overcoming obstacles, both unexpected and anticipated, is vital to your success as a student. Please share an experience where you’ve faced an obstacle, what you learned about yourself, and how to best face them in the future.
Your answer
Have you ever been convicted of a felony?
Yes
No
Have you ever been convicted of Criminal Sexual Conduct?
Yes
No
I affirm that I am a high school graduate, or over the age of 18 and hold a GED.
I have accurately and honestly answered all questions to the best of my ability.
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Send me a copy of my responses.
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