Application Form, American Institute of Medical Massage

Application Form

Please complete this application form and submit electronically using the “Submit” button below.

You will be notified by the email account you include below of our decision.

Thank you for interest.

Name *

First

Last

Current Street Address *

City *

Zip Code *

Email *

Age

Date of Birth *

Sex *

Day / Evening Phone Numbers *

Do you usually finish what you start?

If accepted, are there any obstacles that preclude you from starting school?

If so, what are they?

Are there any obstacles foreseen that may prevent you from completing the program?

Do you have reliable transportation?

Do you have dependable child care (if applicable)?

How do you plan on paying for school?

If parents are paying for school, please complete their contact info

Name

First

Last

Phone Numbers

State three reasons why you feel training at AIMM would benefit you: Reason One

Reason Two

Reason Three

State three reasons you want to become a medical massage therapist:

One

Two

Three

What type of place of employment do you envision yourself in following your graduation?