Application for. Massage Therapist

Transcription

1 Application for Massage Therapist

2 Cumberland Salem Workforce Education Alliance Certified Massage Therapist Do you have a nurturing personality and a passion for helping people? Do you enjoy learning new skills and networking within your community? If so, then consider a career in massage therapy. Cumberland County College has partnered with top massage therapy educators to present this exciting short term career certificate. At the completion of this training program, you will be eligible for a license in therapeutic massage and bodywork and can begin an exciting career in the healing arts. With Americans increasingly interested in holistic medicine, skilled massage therapists are in demand. Part of the rapidly growing allied health field, the job market for massage therapists is projected to grow by 20 percent between now and Licensed massage therapists work in a variety of settings including salons and spas; offices of physicians and chiropractors; fitness and recreational sports centers; hotels and self employment. Massage therapists can specialize in dozens of different types of massage, called modalities. Swedish massage, deep tissue massage, reflexology, acupressure, sports massage, and neuromuscular massage are just a few of the many approaches to massage therapy. Most massage therapists specialize in several modalities. The curriculum consists of 520 hours of training, including lecture and clinical experience. All clinical work is done in our newly renovated classroom on the campus of Cumberland County College. After completion of the initial training program, many of our graduates will seek additional training and go on to take the National Certification Exam for Therapeutic Massage and Bodywork. In addition to learning numerous skills and modalities, you will have an excellent opportunity to build your clientele through our student clinic massage clinic, which is conducted in the security of the classroom. The School of Massage Therapy at Cumberland County College is recognized by the National Certification Board for Therapeutic Massage and Bodywork and the State of New Jersey. The course fees include: lecture, clinical experience, CPR for health care workers, background check and certificate of completion.

3 Application Instructions: 1) All information given on the application form must be typed or neatly printed. 2) A check or money order for $75.00, non-refundable application fee must be enclosed 3) The completed application, and any subsequent correspondence, must be mailed to the Cumberland Salem Workforce Education Alliance, PO Box 1500, Vineland, NJ Attention: Nancy Pollard 4) Arrange for an official copy of your high school, GED and/or college transcript(s) to be forwarded to Professional & Community Education Department by calling or writing to your high school and/or college(s) or assigned designation if your school no longer exists. Copies of high school diplomas are not acceptable. 5) Applicants are required to ask two individuals to provide letters of recommendation in support of their application. These references may not be family members. References should be responsible adults who can attest to your ability to successfully complete this training (e.g., employers, instructors, advisors, clergy or medical personnel). References are to be mailed by these individuals to the Professional & Community Education Department. 7) Applicants must submit the Immunization & Tests form along with their application, showing proof of Hepatitis B vaccination ( 3 shot series) and recent (one year or less) tuberculin test. 8) In order for the application to be considered, it must be complete.

4 Massage Therapist Certification Program APPLICATION Please type or print clearly and mail to: Cumberland County College, Cumberland Salem Workforce Education Alliance, PO Box 1500, Vineland, NJ Attention: Nancy Pollard Name Last First Middle Other/Previous Name (which may appear on records) Address Number & Street Apt. Number City State Zip code Phone: Home: ( ) Work: ( ) Social Security Number Date of Birth How did you hear about the Massage Therapist Training Program? Extra Curricular Activities (please list all school, community or religious activities in which you have participated. Include all offices which you have held and honors you have received.) Provide names and address of the two persons from whom you have requested recommendations. These references must not be family members. At least one reference must come from a former employer or teacher. All references should be responsible adults who can attest to your ability to successfully complete this training. Name Title/Position

5 Address Phone ( ) Relationship to Applicant Name Title/Position Address Phone ( ) Relationship to Applicant Educational Background School City Dates Attended Degree High School College Special Certification Employment Present Employer Phone ( ) Address Dates of Employment Nature of Work Name of Employer Phone ( ) Address Dates of Employment Nature of Work

6 Statement of Interest Please explain why you wish to work in the health care industry as a Massage Therapist: Applicant s Name Date

7 Massage Therapist Certification Program Certificate of Information I certify, to the best of my knowledge, that the information supplied on this application is complete and accurate. Applicants signature Date Cumberland County College admits students without regard for race, color, creed, sex, age, religion, national/ethnic origin, sexual orientation, disability, pregnancy or military status.

8 Certified Massage Therapist Immunization & Tests Name Age Sex Address City State Zip Immunization & Test History Vaccine Dose Date Hepatitis B 1. / / 2. / / 3. / / Tuberculin Tests Arm / Device / Antigen / Manufacturer Dates Applied / / / Date Read Results (mm) Signature of Examiner Print Name of Examiner Address City State Zip Date

9 RELEASE OF INFORMATION FORM I, (print name), authorize Cumberland Salem Workforce Education Alliance to release all of my records pertaining to my criminal history, which includes my name, social security number, date of birth, address, and student ID number to IdentityPi.com. I understand that the use of my records is limited to and in connection with any audit and the evaluation of continuing education programs, and in connection with the enforcement of the federal and/or state laws. My signature is an acknowledgement that I have read and voluntarily consent to the release of the above-mentioned information. Student Signature Date Address Social Security # Phone Number *SSN is used for criminal background check purposes only cccreleaseofinformationform

10 Application Checklist check or money order and $75.00, GED and/or college transcript(s) forwarded to Cumberland Salem Workforce Education Alliance Background check waiver. s of recommendation forwarded to Cumberland Salem Workforce Education Alliance Immunization records for: Hepatitis B TB screen