Student Admissions Application

Applicant Name:*
Date of Birth:*
Social Security Number:*
Address:*
Home Phone:
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Cell Phone:*
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Work Phone:
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Email Address:*
How did you hear about us?*
Race:*
Disability:*
(Please explain):

Ability to Benefit
- Must be a high school graduate (information below)
- Ability to lift 50 lbs (demonstrate set-up of massage table)
- Basic computer skills (email, CD materials, resume, etc.)
- Washing State Patrol Background Check

Highest Grade Completed

Name of High School:
Graduation Date:
GED:
Date GED Attained:
Post High School:
What type of training?:
Certification (2yrs):
What type of certification training?:
Associate Degree (Name of College or Training Institute):
Dates Attended:
Bachelors Degree (Name of College or Training Institute:
Bachelors Dates Attended:
Current Employer (Name):
Phone Current Employer:
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Interested in Day or Evening Classes:*
Interested in Fall, Winter, Spring or Summer Session start?*
Sign up for our newsletter and receive school information about Massage School Programs, Student Clinic and Community Massage events:
In Case of Emergency Contact (Name):*
Relationship:*
Phone Emergency Contact:*
I verify all information is accurate:*
Date:*
Please write one or two paragraphs why you want to become a massage practitioner?:*
CAPTCHA: