Application Process

Program of Interest

Massage Therapy Diploma (1,000 hours)

September start:

January start:

June start:

Relaxation Massage Certificate (250 hours)

September start:

January start:

May start:

Personal Data

First Name:

Last Name:

Email Address:

Permanent Mailing Address:

City/Town:

Province: Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut Yukon Territory Outside of Canada

Postal Code:

Telephone (Day):

Telephone (Evening):

Date of Birth: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Sex: Male Female

Education Data

Secondary School:

Secondary School City/Town:

Last Grade Completed:

Years of Attendance:

Post Secondary Institution:

Post Secondary City/Town:

Degree, Diploma, or Certificate completed:

Employment History

Please list your occupations in the past two years, beginning with your most recent.

Most recent employer

Occupation :

Employer :

Contact Person :

Telephone Number :

2nd most recent employer

Occupation :

Employer :

Contact Person :

Telephone Number :

3rd most recent employer

Occupation :

Employer :

Contact Person :

Telephone Number :

4th most recent employer

Occupation :

Employer :

Contact Person :

Telephone Number :

Questionnaire

(For Massage Therapy Applicants only):

1. Why do you want to become a massage therapist?

2. What are your expectations of yourself as a student?

3. What are your expectations of our program?

4. What do you personally have to offer the career of massage therapy?

5. What massage experiences do you have?

6. What role should massage therapy play the health care field?

By pressing Submit you release your information to the Professional Institute of Massage Therapy. A school official will be in contact with you to advise you of the status of your application and of further documentation required to determine your admission to the school.