ITEC Level 5 Certificate in Sports Massage Therapy - Application form 2021-22  
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International Therapy Examination Council
ITEC Level 5 Certificate in Sports Massage Therapy
Please allow 10-20 minutes to complete the form
Please note:  You cannot partially complete the application form and return to it, if you leave the form you will have to start again
Guidelines
For guidance, please refer to the prospectus or see our website:
www.citylit.ac.uk 

Please read the relevant course outline, including skills statement and application guidelines before filling in this form.

When you apply to join an accredited course we will expect that you:

•  Meet the entry requirements for the course before you can enrol – these will be detailed on the course outline

•  Provide full and accurate information and evidence about any prior achievements, as requested

•  Tell us about any changes or corrections to your original application

•  Discuss with us any support you may need for the interview and the course

•  Offer feedback about the application and interview process


Transfers & Refunds
PLEASE NOTE, this course is excluded from the City Lit transfer and refund policy.

Transfers
Due to the nature of this course, you will not be entitled to transfer to a different course after the course has started. There is an assessment process and extensive information available in the course outline and online.  Please ensure that this is the right course for you before enrolling.

Refunds
Cancellation of this course can only be made up to three weeks (21 days) prior to the course commencing.  For courses cancelling prior to this a refund will be given less a 20% administration fee.

This does not affect your statutory rights

Course Pre-requisites
*  You must have an ITEC Level 3 Diploma in Sports Massage Therapy or equivalent.


 
Required Pre-requisites (Tick all that apply) *
Required
Please tell us what relevant qualification have *
Personal details
Forename *
Surname *
Post code *
Date of Birth *
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Mobile number
Telephone (day)
Email address *
Country of domicile *
Course details
ITEC Level 5 Certificate in Sports Massage Therapy
Work / Employment experience
Are you employed at present? *
Required
If so, what is your job?
Education
It is important to think about the skills you will need in order to get the most out of your chosen course. Please read the course outline carefully, in particular the skills section, to check the English and maths skills you need to start a course. During your application and interview process we will assess these skills and may recommend you undertake support alongside your chosen course or attend an alternative course that will prepare you for your long term study plans. If you have any queries, please contact us for assistance.
Do you have a maths qualification
if so, please state
Do you have an English qualification?
if so, please state
Experience / Other Training
Do you have any previous experience of the subject you wish to study?
 (If you have attended an introductory course, please say when and where.)
Long-term aims
What are your long-term aims? (Study or work wise).
Disability
If you consider yourself to have a disability, please give details indicating the type of additional support you might need below:  (e.g.  Dyslexia support, Communicator, Specialist Equipment) If you are unsure if you will require any additional support, please let us know and we can discuss your situation and requirements.
Would you classify yourself as: *
Required
type of disability / support needs
Special Requirements / considerations
Are there any other special requirements/considerations which you feel we need to know about?
Personal Statement
NB this personal statement is part of the assessment process and will help us to determine that the course is at the right level for you.  Please ensure that it is your own work, We are looking for a minimum of 3 short paragraphs which must be:
•  well organised and structured (Introduction / main body / summary)
•  complete sentences which follow a logical order
•  accurate spelling and punctuation

Personal Statement
Do let us know as much as possible about yourself in your written statement, why you wish to take the course, and any experience you may have in relation to the subject.  
Health & Safety
Health Checklist Please tick if you have, or have had, any of the following:
Please tick the boxes below *
yes
no
epilepsy
diabetes
an untreated medical condition
cardiovascular disorders (high blood pressure, severe varicose veins, heart problems, thrombosis)
Endocrine disorders
Spinal injuries
Severe mental illness
severe skin disorders
pregnancy (or post natal)
Bone or joint disorders (rheumatoid arthritis, osteoporosis)
Allergies
Is there anything else we should know about your health?
If so, please provide details below:    
Medical referral / disclaimer
If you have ticked YES to any of the conditions listed, please check with a medical practitioner whether it is suitable for you to undertake a bodywork course and bring a referral letter from your doctor.

Alternatively, you may sign the disclaimer below

I hereby accept responsibility for my own health and do not hold the trainee therapist / City Lit responsible for any responses as a result of receiving treatment.

Signature
by entering your name you are providing an electronic signature and confirmation that you agree with the above statement
Date
MM
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Statement of commitment
Regular attendance as well as reading and written work will be expected from you during these courses.  You will also be expected to complete any assessment and/or exams required for your chosen course at the dates and times supplied by the Institute.
Are you willing to commit yourself to this course and are you sure you have time for it? *
Required
Have you carefully read the relevant course outline, guidance notes and this application form and are you willing to abide by the protocol outlined? *
Required
Electronic signature
By entering your name here you are providing an electronic signature and confirm that all the information given is (to the best of your knowledge) correct. *
How did you hear about our course? *
Required
Date of signature *
MM
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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