Apply Online

First Name

Middle Name

Last Name

SSN#

Birth Date

Phone Number

Email Address

Street Address

City

State

Zip Code

Referral

Name of High School

Graduation Date

Briefly explain why you want to be a Massage Therapist

Do you have any medical conditions that may affect your ability to complete massage therapy training or your performance as a massage therapist in the future?

Yes No

If yes, please explain, in detail:

Have you ever been convicted of a felony or misdeamenor other than traffic offenses?

Yes No

If yes, please explain, to the best of your ability:

Are you considering financing all or part of your financial obligations for this course?

Yes No

Full Name

Phone Number

Full Name

Phone Number

Age Requirement

By submitting my application to Alpena Institute of Massage, I acknowledge and understand that in order to be considered for enrollment, I must be at least 18 years of age or older. I confirm that I meet this age requirement and will provide valid identification as proof, if requested by the institute. I understand that failure to meet the age requirement may result in the rejection of my application.

Terms & Conditions

By agreeing to this statement, I affirm that I have read, understood, and fully comply with terms and conditions for enrollment at Alpena Institute of Massage.

Applicant Certification & Acknowledgement

I certify that the statements I have made in this application are complete and true to the best of my knowledge. I acknowledge that it is my responsibility to be aware of all pertinent admission and application requirements. I acknowledge that failure to disclose complete and accurate information, or failure to submit all required application materials may result in the denial of admission or subsequent dismissal from the Alpena Institute of Massage.

Signature

Today's Date