Massage Therapy Programs
Online Application for Admission


PERSONAL DATA:

First Name *
Last Name *
Address 1 *
Address 2
City *
State *
Zip Code *
Email Address *
Home Phone *
Work Phone *
Birth Date (MM/DD/YY) *
Social Security Number *
Citizenship *



PROGRAM:

Select the program you are applying for from the list below.

 Click here to select this course
Location:
Orlando, FL

Start

End
10/02/061/26/07
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
ResMTWTF
Tuition:
$5,199.00

Start

End
9:15am3:00pm

 Click here to select this course
Location:
Orlando, FL

Start

End
11/20/065/17/07
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
PMMTWT
Tuition:
$5,199.00

Start

End
5:15pm10:30pm

 Click here to select this course
Location:
Orlando, FL

Start

End
5/30/0611/16/06
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
PMMTWT
Tuition:
$5,199.00

Start

End
5:15pm10:30pm

 Click here to select this course
Location:
Orlando, FL

Start

End
9/4/071/19/08
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
AMMTWTF
Tuition:
$5,999.00

Start

End
9:00am3:00pm

 Click here to select this course
Location:
Orlando, FL

Start

End
7/24/061/18/07
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
PMMTWT
Tuition:
$5,199.00

Start

End
5:15pm10:30pm

 Click here to select this course
Location:
Orlando, FL

Start

End
2/04/07 5/25/07
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
ResMTWTF
Tuition:
$5,199.00

Start

End
9:15am3:00pm

 Click here to select this course
Location:
Orlando, FL

Start

End
6/04/07 9/21/07
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
ResMTWTF
Tuition:
$5,199.00

Start

End
9:15am3:00pm

 Click here to select this course
Location:
Orlando, FL

Start

End
10/01/07 1/25/08
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
ResMTWTF
Tuition:
$5,199.00

Start

End
9:15am3:00pm

 Click here to select this course
Location:
Orlando, FL

Start

End
2/04/085/23/08
Course:
500 Hr Massage Therapy
FormatDay Of Wk.
ResMTWTF
Tuition:
$5,199.00

Start

End
9:15am3:00pm



EDUCATION:

List educational institutions attended with the most recent first. Official transcripts MUST be submitted before a Certificate will be granted.

School Name 1
City / State
Dates From / To
Degree Earned


School Name 2

City / State
Dates From / To
Degree Earned



EMPLOYMENT:

List current or most recent employment.

Employer
Address
City / State
Phone
Job Descrption
Dates Employed



HEALTH RECORD:

Have you had any contagious diseases in the past 2 years?

If yes, please explain:


Do you have any health related issues the school should be aware of?


If yes, please explain:



REFERENCES:

Reference #1
Name
Address
City
State
Zip Code
Phone
Relationship

Reference #2
Name
Address
City
State
Zip Code
Phone
Relationship



OTHER:

Have you ever been convicted of a felony?

If yes, please explain:



CERTIFICATION:

Type your full name in the space below to indicate that you believe the information provided above is true and complete.
Full Name *



PAYMENT:

Provide your charge card information for the $75.00 registration fee. The $75.00 registration fee is refundable prior to the first day of class.

Note: The registration fee for Florida is $50.00 and is non-refundable.


Name On Card *
Card Type *
Card Number *
Experation Date *



PROCESS APPLICATION:

If you want a copy of this page for your records,
print it now before you submit the page.

Click on the Submit button just once. Depending on Internet traffic and server load it may take up to one minute for the order to be processed. However, if nothing seems to be happening, feel free to click again. You will not be billed twice.