Massage Training - Massage Training Institute, Montana

MASSAGE TRAINING INSTITUTE

Application

(There is no application fee)

Date*
MM slash DD slash YYYY
Name*
First Middle Last
Date of Birth*
MM slash DD slash YYYY
Address*
Mailing Address City State / Province / Region ZIP / Postal Code
Phone*
Email Address*
In Case Of Emergency, Please Contact:
Name*
First Last
Relationship to Student*
Address*
Street Address City ZIP / Postal Code
How Did You Hear About Our School?
- Fall Class
Education
Name of High School City State / Province / Region
Dates Attended
MM slash DD slash YYYY
Date Graduated
MM slash DD slash YYYY
Education
Name of University or College City State / Province / Region
Name Recorded on Transcript (if Different From Application)
Degree or Certification
Personal Legal Information:

Please be aware that if you answer yes to any question below, your ability to obtain a License to practice massage in the State of Montana or elsewhere may be impeded or prohibited.
Have you ever been convicted of, or entered a plea of guilty, or no contest to, a crime in any jurisdiction other than a minor traffic offense? (This includes misdemeanors, felonies, and withheld adjudications. Driving under the influence or driving while impaired is NOT a minor traffic offense for purposes of this question.)
- YES
- NO
In the last 5 years, have you been enrolled in, required to enter into, or participated in any drug or alcohol recovery program or impaired practitioner program?
- YES
- NO
In the last 5 years have you been treated for or had a recurrence of a diagnosed mental disorder or impairment?
- YES
- NO
In the last 5 years, have you been treated for or had a recurrence of a diagnosed addictive disorder?
- YES
- NO
Please Include The Following Materials With This Application:
A copy of your Drivers License
Max. file size: 100 MB.
A copy of your High School Diploma, GED, or college transcripts
Max. file size: 100 MB.
A brief biographical sketch explaining your motivation for training in massage.
Max. file size: 100 MB.

Please Mail This Application To:

Massage Training Institute
Attn: Michael Eayrs
1500 Airport Rd.
Kalispell, Montana 59901

MASSAGE TRAINING INSTITUTE

Application

In Case Of Emergency, Please Contact:

Personal Legal Information:

Please be aware that if you answer yes to any question below, your ability to obtain a License to practice massage in the State of Montana or elsewhere may be impeded or prohibited.

Please Include The Following Materials With This Application:

Please Mail This Application To: