Day Schedule OR Evening Schedule (30 weeks) (42 weeks) 9:00 am 3:30 pm 5:00 pm 9:30 pm

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1 Massage Therapy Program Application Packet Locklin Tech s Massage Therapy Program is designed to prepare students to meet the need for qualified and licensed massage therapists to work in various settings that could include hospitals, clinics, nursing homes, chiropractic offices, cosmetology salons, sports clinics, rehab and physical therapy centers, private practices and spas. Laboratory activities and clinical practicum experiences are an integral part of this program. This program is approved by the Florida Department of Health and the Board of Massage Therapy so graduates may take the board approved examination to practice as massage therapists. According to the Occupational Outlook Handbook, employment for massage therapists is expected to increase 20% from 2006 to The coursework includes: HSC0003 Basic Healthcare Worker 90 Hours MSS0205 Massage Therapist Hours MSS0206 Massage Therapist Hours Pre-Admission Massage Therapy Requirements must be submitted by May 30th and include: Complete and submit an application to Locklin Tech for admission along with: A. The $15.00 non-refundable application fee when the application is submitted. B. Transcripts from high school as well as any post-secondary institutions you have attended. A minimum GPA of 2.0 is required on all transcripts. C. Scores from the Test of Adult Basic Education (TABE). Student Services at Locklin Tech can provide more infor mation on exemptions and testing dates for the TABE. D. Complete Proof of Residency form and provide copies of documentation required. 2. If you are not going to be a self-pay student, complete a financial aid form online at Be sure to include Locklin Tech s school code If you are eligible for Veterans Benefits complete the online infor mation at 3. Enrollment is limited to 16 students per class. 4. All applications will be reviewed and students will be notified by June 20, Schedule for Massage Therapy Program: Day Schedule OR Evening Schedule Monday-Thursday Monday-Thursday (30 weeks) (42 weeks) 9:00 am 3:30 pm 5:00 pm 9:30 pm If you are accepted in the Massage Therapy Program you must complete and submit the following to Student Services by July 15th: Results of a recent physical exam. Hepatitis B information form completed. List of current immunizations. Pay tuition if a self pay student OR have approval from Locklin Tech s financial aid counselor if receiving PELL or VA Benefits and/or have documentation from any additional funding sources such as Vocational Rehab, Workforce Investment Act or Scholarships. Failure to meet the deadline will forfeit your enrollment in the program. Updated:

2 Cost of Attendance for Massage Therapy Program: Day Schedule Evening Schedule *Other Expenses 1st Semester August 18~December 22, 2014 $1, Hours $ Hours 2nd Semester January 6~May 29, 2015 $1, Hours $1, Hours Summer Term June 8~July 14, 2015 N/A $ Hours Texts $500 Uniforms $150 Supplies $ 25 FL Board License CPR National License TABE Testing Parking Fee $160 $ 30 $250 $ 20 $ 5 *Expenses are estimates and are subject to change.

3 AMT DUE INITIALS COMMENTS APPLICATION FOR ADULT STUDENTS New Student Returning Student Please PRINT Legibly START DATE SCHEDULE FULL TIME Morning ONLY Afternoon ONLY ON LINE NAME SOCIAL SECURITY # Last First Middle ADDRESS Street City State Zip RESIDENCE PHONE _( ) CELL PHONE ( ) ADDRESS DATE OF BIRTH ETHNIC/RACE CHECK ALL THAT APPLY White Black Hispanic Asian Indian Multiracial Pacific Islander SEX Male Female PLACE OF BIRTH EDUCATION LEVEL GED HS Diploma & Year Certificate Program AA/AS Degree BA/BS Degree HAS ANY OF YOUR EDUCATION BEEN OBTAINED OUTSIDE THE UNITED STATES? No Yes (Explain) WHAT OTHER POST-SECONDARY INSTITUTIONS HAVE YOU ATTENDED? DOES ANY OF YOUR PREVIOUS EDUCATION RELATE TO THIS LOCKLIN PROGRAM? No Yes (Explain) DEGREES EARNED THIS IS THE FIRST TIME I HAVE ENROLLED IN A POST-SECONDARY SCHOOL PROGRAMS ON CAMPUS A/C, REFRIGERATION, & HEATING TECH I 750 HRS A/C, REFRIGERATION, & HEATING TECH II 600 HRS APPLIED CYBERSECURITY 900 HRS APPLIED WELDING TECH 1170 HRS DAY PROGRAM APPLIED WELDING TECH 1170 HRS EVENING PROGRAM AUTO SERVICE TECH I 1050 HRS AUTO SERVICE TECH II 750 HRS CERTIFIED NURSING ASSISTANT 165 HRS COMPUTER SYSTEMS & INFORMATION TECH 900 HRS COMM FOODS & CULINARY ARTS 1200 HRS ELECTRICITY 1200 HRS MASSAGE THERAPY 750 HRS DAY PROGRAM MASSAGE THERAPY 750 HRS EVENING PROGRAM PHARMACY TECH 1050 HRS PRACTICAL NURSE (LPN) 1350 HRS PROGRAMS ONLINE ONLY LEGAL ADMINISTRATIVE SPECIALIST 1050 HRS MEDICAL ADMINISTRATIVE SPECIALIST 1050 HRS APPRENTICESHIP PROGRAM A/C, REFRIGERATION, & HEATING TECH Are you a Veteran? Yes No REASON FOR TAKING CLASS (CHECK ONE) To acquire entry level occupational skills necessary to obtain employment, or retrain for a new occupation. To enable persons who are or have been employed in a specific occupation to upgrade their competencies in order to reenter or maintain stability or advance with their occupation. For personal enrichment or recreation. FINANCIAL ASSISTANCE (CHECK ALL THAT APPLY) Are you receiving VA Education Benefits? Yes No Financial assistance you qualify for PELL Vocational Rehab Workforce Investment Act Scholarship (type of scholarship EMPLOYMENT STATUS Unemployed but available Unemployed not available Employed Employer s Name & Address: Previous employment related to the program you are enrolling in may earn you credit/hours. Do you have any previous employment that may relate to your program? No Yes (explain) OFFICE USE ONLY DATE RECEIPT # FEE PAID OFFICER CONTINUE ON BACK OF APPLICATION

4 NAME PROGRAM BACKGROUND SCREENING If your answer is YES to the two statements below, you must submit a full statement of relevant facts and attach to your application. Also, you may be required to furnish the school with all official documents explaining the final deposition of the proceedings. If your records have been expunged pursuant to applicable law, you are not required to answer YES to these questions. If you are unsure whether you should answer YES, we strongly suggest that you answer YES and fully disclose all incidents. By doing so, you can avoid any risk of disciplinary action or revocation of your registration. 1. Have you ever been charged with or subject to disciplinary actions for scholastic or any type of misconduct at any educational institution? YES NO 2. Have you ever been charged with a violation of the law which resulted in probation, community service, a jail sentence or the revocation or suspension of your driver s license (including traffic violations which resulted in a fine of $200 or more)? YES NO ATTENDANCE POLICY I understand that I will be withdrawn following 6 consecutive absences unless pre-approved by the instructor and/or student services. I understand that excessive absences will affect my continued enrollment, grades and financial aid and may result in an administrative withdrawal. BASIC SKILLS ATTAINMENT I understand that I must obtain the basic skills required, as determined by the Test of Adult Basic Education (TABE) scores, in order to complete the program in which I am enrolling. If my TABE scores are not sufficient, I will participate in Applied Academics for Adult Students in order to achieve the basic skills required. STUDENT HANDBOOK & STUDENT CODE OF CONDUCT I understand that I am responsible for understanding the rules and regulations of the Santa Rosa County School District as defined in the Student Code of Conduct, as well as Locklin Tech s Student Handbook. Violation of policy may result in an administrative withdrawal. STUDENTS WITH DISABILITIES I understand that if I am a student with a disability that I may request reasonable changes for certain admission requirements and for course substitutions for program completion. REFUND POLICY I understand that refunds will be made at a prorated amount during the first TWO WEEKS (10 school days) of a student s enrollment. The $15 application fee is non-refundable. NO REFUNDS will be made after a student has been enrolled in class for a period of two weeks or longer. Financial aid recipients should refer to the refund policy in the Student Handbook. Student s Signature I CERTIFY THAT ALL OF THE ABOVE INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. Student Signature Date OTHER NAME(S) WHICH YOU MAY BE IDENTIFIED IN THE SRC SCHOOL DISTRICT RECORDS REVISED 04.14

5 Locklin Tech Knowledge that Works INFORMATION FOR RESIDENCY CLASSIFICATION A Florida "resident for tuition purposes" is a person who has, or a dependent person whose parent or legal guardian has, established and maintained legal residency in Florida for at least twelve months. Residence in Florida must be as a bona fide domicile rather than for the purpose of maintaining a residence incident to enrollment at an institution of higher education. To qualify as a Florida resident for tuition purposes, you must be a U.S. Citizen, permanent resident alien, or legal alien granted indefinite stay by the U.S. Citizenship & Immigration Services. Other persons not meeting the twelve-month legal residence requirement may be classified as Florida resident for tuition purposes only if they fall within one of the limited special categories authorized by the Florida Legislature and Board of Governors. All other persons are ineligible for classification as a Florida "resident for tuition purposes." Living in or attending school in Florida will not, in itself, establish legal residence. Students who depend on out-ofstate parents for support are presumed to be legal residents of the same state as their parents. FLORIDA RESIDENTS This section must be completed in full if you claim Florida residency for tuition purposes. ATTACH COPIES OF DOCUMENTATION REQUIRED A notarized copy of your and/or your parents' most recent tax return or other documentation may be requested to establish dependence/independence. A. I am an independent person and have maintained legal residence in Florida for at least 12 months. (Required: proof of status) B. I am a dependent person and my parent or legal guardian has maintained legal residence in Florida for at least 12 months. C. I am a dependent person who has resided for five years with an adult relative other than my parent or legal guardian, and my relative has maintained legal residence in Florida for at least 12 months. (Required: copy of most recent tax return on which you were claimed as a dependent or other proof of dependency.) D. According to U.S. Citizenship and Immigration Services, I am a permanent resident alien or other legal alien granted indefinite stay and have maintained a domicile in Florida for at least twelve months. (Required: USCIS documentation and proof of Florida residency status.) G. I am a dependent child of a member of the armed services of the United States who is stationed in Florida on active military duty pursuant to military orders, or whose home of record is Florida. (Required: copy of military orders or DD2058 showing home of record.) H. I am a dependent child of a full-time instructional or administrative employee employed by a Florida public school, community college or institution of higher education. (Required: copy of employment verification.) Person claiming residency must complete this section in full Documents supporting the establishment of legal residence must be dated, issued, or filed 12 months before the first day of classes of the term for which a Florida resident classification is sought. All documentation is subject to verification. Additional documentation other than what is required above may be requested in some cases. Please Print: 1. Name of Student: 2. Student s Date of Birth: / / 3. Name of Person claiming Florida residency: 4. Claimant s Relationship to Student: 5. Claimant s permanent legal address: Street/P.O. Box Apt. No. City State Zip Code 6. Claimant s telephone number: ( ) 7. Date claimant began establishing legal Florida Residence and domicile: / / Please complete information for 2 of the 3 following documents*: 8. Claimant s voter registration: State: Number: County: Original Issue Date: / / 9. Claimant s driver s license: State: Number: County: Original Issue Date: / / 10. Claimant s Vehicle Registration: State: Tag Number: County: Original Issue Date: / / Note: Other documentation as defined in s (3)(c) may be used in cases where the documents above are unavailable or are not dated, issued, or filed 12 months before the start of the term. 11. Non-U.S. Citizen only: Resident Alien Number: Original Issue Date: / / Copy of card required I do hereby swear or affirm that the above named student meets all requirements indicated in the checked category above for classification as a Florida resident for tuition purposes. I understand that a false statement in this affidavit will subject me to penalties for making a false statement pursuant to , Florida Statutes, and to FBOG Rule 6A and 6A F.A.C. Signature of person claiming Florida Residency (as listed in Item #3 above) Date 05.12

6 FINANCIAL AID OFFICE Application Procedures Thank you for choosing Locklin Tech for your education! Please follow the checklist below, which will guide you through the steps required to measure your financial need and determine your eligibility. If you have questions, contact the Financial Aid Office for assistance at ext. 209 or How to determine if you are a dependent or independent student: Were you born before January 1, 1991? Are you married? (Answer Yes if you are separated but not divorced.) At the beginning of the school year, will you be working on a master s or doctorate degree program? Are you currently serving on active duty in the U.S. armed forces for purposes other than training? Are you a veteran of the U.S. armed forces? Do you have children who will receive more than half of their support from you between July 1, 2014, and June 30, 2015? Do you have dependents (other than your children or spouse) who live with you and who will receive more than half of their support from you, currently and through June 30, 2015? At any time since you turned age 13, were both your parents deceased, were you in foster care, or were you a dependent or ward of the court? Has it been decided by a court in your state of legal residence that you are an emancipated minor or that you are in a legal guardianship? At any time on or after July 1, 2013, were you determined to be an unaccompanied youth who was homeless, as determined by: (a) your high school or district homeless liaison or (b) the director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development? At any time on or after July 1, 2013, did the director of a runaway or homeless youth basic center or transitional living program determine that you were an unaccompanied youth who was homeless or were self-supporting and at risk of being homeless? Did you answer Yes to any of the questions? If so, then for federal student aid purposes, you re considered to be an independent student and do not have to provide information about your parents on the FAFSA. Did you answer No to every question? If so, then for federal student aid purposes, you re considered to be a dependent student, and you must provide information about your parents on the FAFSA.

7 2. Paperwork Here s a checklist! You should have the following information available to you as you fill out the FAFSA: Your Social Security Number Your parents Social Security Numbers if you are providing parental information Your driver s license number if you have one Federal tax information for tax return filers use the IRS Data Retrieval Tool that is part of FAFSA on the web. This tool will allow you to transfer 2013 IRS income information directly into the FAFSA. Locklin Tech requires all tax return filers to use the IRS Data Retrieval Tool. In rare circumstances, Locklin Tech may allow the student to submit a 2013 IRS tax return transcript not a photocopy of the income tax return. To obtain an IRS tax return transcript, go to and click on the Order a Return or Account Transcript link, or call Make sure to request the IRS tax return transcript and not the IRS tax account transcript. For tax return non-filers, the student must report and list any employers during 2013 and the amount earned from each employer. The student may also be required to obtain written documentation from the IRS stating that the student was not required to file a tax return for If you have low or no income, you must document how you are able to live on reduced or no income. Extra forms will be required for verification purposes. 3. Complete your FAFSA Application ON-LINE Go to: to complete your on-line application. Locklin Tech s school code number is Instructions are provided for each FAFSA question in the Help and Hints section on the right side of the page and are also available by clicking Need Help? at the bottom of the page. Be patient! The FAFSA is user-friendly and easy to complete--follow the steps and read each question carefully. If you need help with your online application or PIN, please STOP and call for assistance. The helpline is available daytime, nights and weekends. 4. Check your EFC After you finish your FAFSA, you will receive your student aid report (SAR) via , or postal mail if you did not give an address. Your SAR has your Expected Family Contribution (EFC) number. This number is basically a measurement of your financial strength and is used by the Financial Aid Office to determine your eligibility. Upon receipt of your SAR, contact Locklin Tech Student Services/Financial Aid at ext. 209 or 211 to make an appointment with the Financial Aid Counselor.