Fields marked with a * are required
I. Personal Information
District of Columbia
Zip / Post Code
Date of Birth (xx/xx/xxxx)
2. What Class Schedule are you applying for?
March 500 Hr
April 500 Hr
May 500 Hr
II. Academic History
Highest level of education
High School or GED
Transferring in massage school credits?
III. Enrollment Questions
1. What are your learning strengths and weaknesses?
2. Do you have a current diagnosis that entitles you to accommodations such as Dyslexia, Disgraphia, hearing or visual impairments, etc.
If yes, please explain. If no, please type NA
3. Do you have any personal issues giving to or receiving massage from a male or female?
4. Do you have any health concerns or conditions that might inhibit you from practicing or participating in all parts of the program?* (Health conditions can include, but are not limited to, mental illness, pregnancy, skin conditions or communicable diseases).
If yes, please explain. If no, please type NA.
6. Have you ever been convicted of a sexually-oriented crime?
7. Are you currently involved with or employed by a sexually-oriented business?
IV: Sign your Application
By typing your full, legal name below, you are indicating that the information you provided on this form is true.
I understand that I am signing this form electronically. Initial.
I certify that I have truthfully completed this application. Initial.
If you need to make changes to your application, you will need to
contact an admissions counselor immediately.