Massage Program Application
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NAME *
Which schedule are you able to attend? *
EMAIL *
PHONE *
MAILING ADDRESS *
DATE OF BIRTH *
MM
/
DD
/
YYYY
CITIZENSHIP *
Do you have a social security number? *
Do you have a criminal record that could possibly prevent you from getting a massage license? *
What is your current occupation? *
Why do you want to become a Massage Therapist? *
Do you have any physical health issues that we need to be aware of? *
Do you have any mental health issues that we need to be aware of? *
We do not accept financial aid, are you prepared to make payments for the tuition or use your GI Bill? *
An admissions advisor will contact you shortly. What time of day is best for you? *
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