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West by Northwest School of Massage
Student Application
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Email *
Full Legal Name *
Other names used (maiden, nicknames) *
Social Security Number (used only for Washington State Workforce Training Board report.  We do NOT run your credit and this is a private form). If you prefer to leave this out, please fill it will zeros. *
The following questions are used for Washington State Workforce and Training Board.  This form is private and you choose the answer that best fits your description.
What is your race?   *
What Gender do you identify with? *
Do you have a disability?  This can be physical, mental and/or learning.  Does not need to be diagnosed. *
Are you a Veteran? *
What level of Education have you completed? *
Thank you for filling out the above information.  Please continue with the form for consideration for one of our Massage Therapy Certification programs.
Which program are you interested in? *
Required
What does your financial plan look like to pay for school? *
Are you a displaced worker applying to use Worker Retraining benefits? *
Full Address: Street, City, State and Zip *
Date of Birth (Month, day year) *
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Pronoun used *
Phone number *
Have you earned a High School diploma or GED equivalent? *
College attended and area of study *
Current Employment *
Other commitments (family, work, volunteering, etc) *
Please write a brief essay on why you would like to attend massage school and what your support network looks like while going through the program. *
West by Northwest School of Massage, LLC is committed to your education, safety and advancement in Massage Therapy.  We require all students and staff to approve a Washington State Patrol Criminal Background check before being accepted into the program.  By agreeing below, you authorize our staff to perform this mandatory safety check before accepting you into any of our programs. *
Worker Retraining benefit verification (Do not fill out if you are not using these benefits).  

Select all that apply, including the Self-Attestation statement.  The information will need to be verified with legal proof or unemployment paystubs.
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