Elite Massage School Application for Admission
The application will take approximately 15 minutes to complete.

Elite Massage School
4009 Bridgeport Way West, Suite E5
University Place, WA 98466
(253) 353 – 2275
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I am applying for admission to *
Applicant First Name *
Applicant Last Name: *
Email Address: *
Date of Birth: *
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Address (Please Include Full Address with Street, City, State, and Zip Code):
 *
Cell / Home Number: Please put in this format: EX: (253) 353 – 2275 *
Work Number: If applicable, please put in this format: EX: (253) 353 – 2275
Highest Grade Completed For High School: *
Graduation Date or Date GED Attained: *
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Name and Address of School *
Highest Grade Completed For College *
College Graduation Date:
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Degree(s) Attained:
Name and Address of College (Most recent)
Current Employer Name: *
Current Employer Address: *
Current Employer Phone Number: Please put in this format: EX: (253) 353 – 2275 *
In Case of an Emergency Contact Name: *
In Case of an Emergency Contact Address:
 *
In Case of an Emergency Contact Phone Number: Please put in this format: EX: (253) 353 – 2275
 *
What is the Relationship Between Emergency Contact and Student: *
How were you referred to us? *
What are your short and long-term goals? *
Tell us about yourself – your interests, attributes, hobbies, etc. *
Why do you want to be a Massage Therapist? *
How do you plan to finance your education?
 *
How soon would you like to start training? *
Are you more of a morning learner (10 AM to 2 PM) or an evening learner (6 PM to 10 PM)?
 *
There is an application fee of $100 that is required when you submit this application.

Application fees are refundable only in the event that you are refused acceptance into the Elite Massage School.

Do you understand and accept this term? *
I have filled out this application to the best of my ability and understand that this is considered a legal document.  Any falsification will result in immediate termination.  I understand that by selecting "I Accept" below; then typing in my First and Last name in the next field; and filling out the date in the following field that I am signing this application electronically.

I agree my electronic signature is the legal equivalent of my manual signature on this Application. By selecting "I Accept" I consent to be legally bound by this Application's terms and conditions. I further agree that the use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide Elite Massage School (EMS) or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes my signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by
me in writing.

I also agree that no certification authority or other third party verification is necessary to validate my E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of my E-Signature or any resulting contract between me and EMS. *
E-Signature of First and Last Name: *
Today's Date: *
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