Massage Therapy Certificate Program Application for Admission 2013

Massage Therapy Certificate Program Application for Admission 2013 Thank you for your interest in the Massage Therapy Certificate Program at Skyline College. To be considered for the program, prospective students must complete all portions of this application. Please read carefully! Incomplete applications will not be considered, and your place in the program will not be assured until all application portions are complete. Application Process 1. Complete the Skyline College Application/Enrollment Processes (available online at www.skylinecollege.edu) 2. Complete the Massage Therapy Certificate Program Application and submit all required elements (available online at http://www.skylinecollege.edu/programsofstudy/business/wellness.html) 3. Complete EMC 425 or equivalent or submit a current, valid Healthcare Provider CPR card APPLICATIONS WILL NOT BE CONSIDERED UNLESS ALL REQUIRED ELEMENTS ARE SUBMITTED. PLEASE SEND THE COMPLETED PACKET TO: Skyline College Wellness Program, Attn: Linda Aldridge Building 8, Business Division 3300 College Drive San Bruno, CA 94066 The Massage Therapy Certificate Program offers one enrollment opportunity each year for the 500-hour, two semester program that starts in the Fall semester and completes in the Spring semester. SCHEDULE DAYS TIMES LOCATION COST Fall Semester Monday through Thursday 6:00 pm - 10:00 pm 4-122 App. $1,300 Spring Semester Monday through Thursday 6:00 pm - 10:00 pm 4-122 App. $560 NOTE: A BACKGROUND CHECK AND PROOF OF FREEDOM FROM TUBERCULOSIS WILL BE REQUIRED AFTER ADMISSION INTO THE PROGRAM. APPLICANTS WILL NOT BE CLEARED FOR ENROLLMENT WITHOUT THESE ELEMENTS. Massage Therapy Certificate Program Admission Application Page 1 of 7 Updated May 9, 2013

Skyline College Massage Therapy Certificate Program Application for Admission Applicant: Complete this form and return to the Wellness Program at the address listed above. Date Student G Number Name Male Female Prefer not to specify Address Number & Street City State Zip Code Home Phone Work Phone Email (please print legibly) Date of Birth Country of Citizenship A full statement of your academic record is required for admission to the Massage Therapy Certificate Program. Please list below the names of your high school, and all colleges and/or universities you have attended. Institution and Address From (Mo/Yr) To (Mo/Yr) Major/Area of Study Degree Received Have you ever been dismissed from any school or college? If so, explain. List full-time occupations to date: Massage Therapy Certificate Program Admission Application Page 2 of 7 Updated May 9, 2013

Do you have prior education in Massage Therapy? Yes No Name of School, Mentor, or Instructor Location Approximate Date of Training Number of Hours Do you have any health limitations that will affect your ability to perform the work required in this profession? Applicants should be able to stand for a period of several hours and be able to bear their body weight on their hands and forearms. Yes No If yes, please explain: How did you hear about the Skyline College Massage Therapy Certificate Program? Explain: Why are you interested in learning Massage Therapy? Please attach a short essay (personal statement) responding to this question. Responses must be at least ½ page in length; may be no longer than 1 page in length; and should be typed if at all possible. Personal statement attached? Yes To be considered for admission, all students must complete the Skyline College English and Math Placement Test within the past two years. The English or Math Placement Test MAY be waived for students who have completed an Associate, Baccalaureate, or higher degree and indicate so on this application. To make a placement test appointment, please go to www.skylinecollege.edu/testing. I hereby certify that the information I have given in this application is complete and correct to the best of my knowledge. I understand that no action will be taken regarding my application until the Massage Therapy Certificate Program has received all documents. Student's Signature Date Return Application To: Skyline College Wellness Program, Attn: Linda Aldridge Building 8, Business Division 3300 College Drive San Bruno, CA 94066 Massage Therapy Certificate Program Admission Application Page 3 of 7 Updated May 9, 2013

MASSAGE THERAPY CERTIFICATE PROGRAM ENROLLMENT CONTRACT PLEASE READ AND SIGN THE SECOND PAGE TO INDICATE THAT YOU UNDERSTAND AND AGREE TO THESE TERMS, REQUIREMENTS, AND REGULATIONS. YOUR SIGNATURE ON THE NEXT PAGE INDICATES THAT YOU UNDERSTAND AND AGREE TO THESE TERMS. A. COURSE REQUIREMENTS 1. Students are required to purchase a kit, textbooks, 2 uniform shirts, and a massage table (unless proof of ownership of a suitable massage table can be provided) for this course. It is imperative that students own a table to enable practice of their massage skills outside of class time each week. Fees for these items must be submitted in the form of separate cashier s checks/money orders on the first class day. Failure to bring payments to class on the first day will constitute grounds for dismissal. 2. It is required that all students receive a professional massage before applying for the program in order to have a kinesthetic experience of massage therapy. Please include with your application documentation of payment for the massage session. Any receipt for massage therapy dated within the last 12 months will be accepted. 3. Students will be giving and receiving massages from both men and women. Proper draping will be practiced at all times to protect the student s privacy. Students agree to work with all other class members. 4. Students will be required to remove all clothing in order to receive a full body massage. Students privacy will always be safeguarded while undressing, dressing, and while receiving a massage. 5. Class is held for 16 hours/week, and students need to allot up to 6 or more hours/week for study and practice. 6. Students should be aware that they may experience psychological and physical responses from receiving massage therapy. B. ATTENDANCE 1. Students need to maintain a C grade or better in the Massage Therapy Certificate Program (WELL 701 and WELL 702) in order to successfully complete the program. A C is 72% or better. 2. Attendance is crucial for program completion. Students are cautioned that, due to the rigorous curriculum in the Massage Therapy Certificate Program, absences need to be reserved for illness or personal emergencies. a. An academic warning will be given when a student is in danger of accruing excessive absence and tardy hours. b. Students must attend a minimum of 500 hours across both semesters of the program in order to complete the program. If any student exceeds the maximum amount of absent/tardy hours (calculated on the basis of 500 hours for minimum attendance), the student will be dropped from the program. The maximum number of absent/tardy hours for 2013-2014 is 48. c. Students are required to attend the full session of each class and should notify the instructor if they need to leave campus during class time for an emergency. 3. Client night/clinic absences: since appointments for client services are made in advance, students must report any absence by calling the school by noon on the day of the absence. 4. Students are responsible for all assignments, even those given during an absence, and it is their responsibility to consult with fellow students and instructors to keep abreast of all studies and requirements. Students are advised to meet with instructors during office hours in order to make up work, get assignments, take make-up quizzes, etc. 5. Performance of make-up work will not reduce absent time accumulated. 6. The dinner break is one-half hour. Students who arrive just before or during the break will not be given credit for the break time. 7. Time will not be granted for outside school activities as a substitute for missed class time (absence/tardy). 8. If students choose not to attend class in observance of a religious holiday, they will be marked as absent. Since Skyline College is a publicly-funded school, religious holidays/holy days are not recognized as reasons for excusable absence, and students who observe these holidays/holy days will do so at their own discretion. 9. Students should keep track of their absences and tardiness hours so they know if they are approaching excess absent hours. 10. Students are advised to communicate with instructors if there is any concern about program standing with regard to attendance or academic progress. If a student is in good academic standing and withdraws from the program for reasonable cause, s/he will still need to reapply for admission. The program will need to be started once again in the Fall semester. 11. All personal belongings must be removed from school property by the end of the last day of the Program. Massage Therapy Certificate Program Admission Application Page 4 of 7 Updated May 9, 2013

C. PERSONAL GROOMING 1. Students agree to come to class practicing good hygiene, being clean and free of perfumed products. 2. Students are required to wear clean attire that permits full movement suitable for performing massage therapy: full-length pants (not baggy sweat pants) and a suitable, short-sleeved shirt are required. 3. Uniform shirts (short-sleeved with Skyline College Massage Therapy Program logo) are required for student clinic/client nights. 4. Flat, closed-toed athletic shoes that allow for stability and balance must be worn. 5. Nails need to be cut below the level of the fingertips with no rough edges; if polish is worn, it should not be distracting or unkempt. 6. Hair should be clean and fashioned in such a way that it does not require touching during a massage treatment. Hair must not interfere with giving a massage. 7. No scarves, hats, or caps will be allowed. 8. Jewelry must not be worn that would interfere with giving a massage, that is, no necklaces, rings, bracelets, and/or wristwatches. 9. Make-up, if worn, should be tasteful and kept to a minimum. D. BEHAVIOR 1. Behavior that is mature, tactful, and courteous is expected when dealing with instructors, instructional aides, fellow students, staff, and clients. Inappropriate behavior will result in dismissal. 2. A student using profanity or inappropriate language will be warned. Continued use of such language may constitute grounds for dismissal. 3. Students are expected to extend instructors the courtesy of silence during lab and lecture classes. They must also refrain from conducting conversations with other students while serving a client. 4. No cell phones, texting devices, pagers, or other forms of media may be used during class time unless expressly permitted by an instructor. 5. No food or drink of any sort, other than water in a closed container, is permitted in any classroom or lab environment. Please sign and return the below portion of the contract with your application. ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ I have read the above contract and I am fully aware that I am responsible for upholding the program s regulations and requirements while I am a student in the Massage Therapy Certificate Program. I agree to abide by all stated rules. Student's Name (Printed) Student's Signature Date Massage Therapy Certificate Program Admission Application Page 5 of 7 Updated May 9, 2013

Skyline College Emergency Contact Form Name Male Female Prefer not to specify Address Number & Street City State Zip Code Home Telephone: Work Telephone: In case of emergency, please notify Relationship to you Day Phone # Evening Phone # Other Phone # Back-up: In case of emergency, please notify Relationship to you Day Phone # Evening Phone # Other Phone # Do you have any disabilities that may require additional assistance and support? Yes No If yes, please describe: Do you have any allergies or health problems? Yes No If yes, please list: Are you currently taking any medications? Yes No If yes, please list: Due to the strenuous nature of the Massage Therapy Certificate Program, we would suggest a complete physical examination prior to enrolling. Regardless of whether or not a physical examination is received, A CURRENT TB TEST RESULT IS REQUIRED. THE TEST MUST HAVE BEEN ADMINISTERED WITHIN THE LAST SIX (6) MONTHS. A NEGATIVE TEST RESULT WILL BE ACCEPTED. IF THE RESULT IS POSITIVE, A NOTE FROM A PHYSICIAN (MD) IS REQUIRED, VERIFYING THAT THE STUDENT IS HEALTHY AND CAPABLE OF PARTICIPATING IN THE PROGRAM. Massage Therapy Certificate Program Admission Application Page 6 of 7 Updated May 9, 2013

Massage Therapy Certificate Program Application Checklist Please use this checklist to ensure that you have completed all required application elements and included them with your application. Include this checklist with your submitted application packet. Name of Applicant Email Address: 1. Copy of Placement Test Results: Math and English (or documentation of degree) 2. Completed Massage Therapy Certificate Application, Signed and Dated (pages 2 and 3), including Personal Statement regarding reasons for wanting to learn about Massage Therapy 3. Signed and Dated Contract (bottom portion of page 5) 4. Completed Skyline Emergency Contact Form, Signed and Dated (page 6) 5. Proof of Freedom from Tuberculosis (negative test result from within the last 6 months or, if result was positive, a physician s [MD s] statement certifying health) 6. Transcript of completion of EMC 425 or equivalent or copy of your valid Healthcare Provider CPR card. Unofficial transcripts for coursework completed through the San Mateo Community College District may be printed through WebSMART and submitted with your application. 7. Documentation/receipt from within the last 12 months showing proof of having received a Professional Massage. 8. Completed Application Checklist Applications will be taken until all class positions are filled. Application Packet must be submitted through the mail or delivered in person to: Skyline College Wellness Program, Attn: Linda Aldridge Building 8, Business Division Office 3300 College Drive San Bruno, CA 9406 Accepted and/or waitlisted applicants will be notified of application status/acceptance through email. IMPORTANT NOTE: Program classes begin on the first weekday of the Fall semester in Building 4, Room 4-102. ***Once a student is accepted, s/he must bring money orders/cashier s checks as instructed to the first night of class or enrollment will be forfeit.*** Massage Therapy Certificate Program Admission Application Page 7 of 7 Updated May 9, 2013