Enrollment Application 

Ready to Embark on Your Massage Therapy Journey?

Answer the following questions to get started!

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Email *
Name *
First and last name
Best phone number to reach you & leave a message *

Is this a mobile phone?
 *
Required
May we text you?

Address

Are you 18 years of age or older?

Date of Birth
MM
/
DD
/
YYYY

Preferred Pronoun(s)

Are you a U.S. citizen

Current Employment Status

Current occupation

Current employer

How did you hear about us? If you were referred, please share by whom.

Preferred Start Date for the Professional Massage Therapy Training Program

Highest Level of Education Received

Please provide a brief assessment of your academic strengths and challenges

This program requires physical participation and some strength. Do you have any limitations* (physical, emotional, mental) that would prohibit you from 100% participation?

What are ways that we can support your learning needs?

Have you ever had a professional massage?
If yes, tell us about it

Please describe what it is about becoming a Licensed Massage Therapist that interests you.

Additionally, tell us why this is the obvious next step for you.

What qualities do you possess that you feel would be an asset to you as a Licensed Massage Therapist?

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.

Have you ever been convicted of a felony?

Have you ever been convicted of Criminal Sexual Conduct?

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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