Admission Application
*Date:
*Program:
*First Name:
*Middle Intial:
*Last Name:
Social Security Number:
*Date of Birth:
*Current Mailing Address:
*City:
*State: *Zip:
Permanent Mailing Address:
(if different from above)
City:
State:
Zip:
*Home Phone:
*Cell:
*Work:
*Email:
*Current Employer:
*Months/Years at Job:
*Job Title:
*Have you ever been convicted of a felony:


If yes, please describe your offense and conviction including dates, place and charge.

Previous Education
*Name of High School/GED:
*City/State:
*Date Graduated:
Name of College/University:
City/State:
Date Graduated:
Name of Vocational School:
City/State:
Date Graduated:
   
*Emergency Contact:
*Phone:
*Nearest Relative/Friend
*Phone:
*Please describe any medical, physical, psychological conditions, including diagnosed learning disabilities that may require special accommodations (if question does not apply, please type "none).
* I certify that all information I have provided is true and complete. By checking this box, I authorize Sage School of Massage to investigate the statements I have made on this application. I understand that any false statement will disqualify me from enrollment, and if discovered after enrollment, will result in immediate dismissal.

To complete your application and be considered for enrollment the following attachments must be received.
  1. $100 Workshop fee (to be applied to tuition if you enroll).
  2. Proof of high school diploma/GED or official transcript from the
    college/university that you graduated from.
  3. Proof of having a professional massage (cancelled check, business card
    signed by therapist etc.).
  4. Documentation of any felony or misdemeanor if applicable.
  5. Submit an essay stating why a career in massage therapy will meet your
    personal/professional goals; how you will pay for your tuition; and your plans
    for adequate study time (with your present family obligations, work schedule,
    childcare etc.). Please type and double space your essay.

Fax, mail or call for an appointment to bring the above attachments to
Sage School of Massage at:

Address: 369 NE Revere Ave. Suite B, Bend, OR 97701
Fax: 541-383-3244
Call: 541-383-2122
All major credit cards are accepted.
*Required Fields