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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*
Current Street Address*
City*
Zip Code*
Email*
Age*
Date of Birth*
Sex*
Day / Evening Phone Numbers*
Do you usually finish what you start?* YesNo
If accepted, are there any obstacles that preclude you from starting school? YesNo
If so, what are they?
Are there any obstacles foreseen that may prevent you from completing the program? YesNo
Do you have reliable transportation? YesNo
Do you have dependable child care (if applicable)? YesNoNot Applicable
How do you plan on paying for school?
If parents are paying for school, please complete their contact info
Name
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
What type of place of employment do you envision yourself in following your graduation?