First Name^*

Last Name^*

Address^*

Email^*

Phone Number

Birthday

Employer

Job Title

Supervisor Name

Supervisor Phone Number

High School:

City/State

Year of Graduation

College University/Technical School:

City/State

Degree/Year

Field

If you have a history of medical problems, please describe the nature of your illness:

Are you currently under medical supervision?

Yes No

Please list any medications you are currently taking:

Please describe any physical challenges you have which may influence your performance as a massage therapist:

Please describe any learning challenges you have that could impact your success in this program:

Please describe any mental or emotional challenges you have that could impact your success in this program:

Please list the massage therapist from whom you have received at least 1 professional massage:

Please list any previous massage or bodywork experience/training:

Please describe any criminal record you have that could impact your ability to obtain a Wisconsin Massage Therapy License:

Class for which you are applying (list Day Class/Accelerated Class/Night Class and start date):

Tell us about yourself (interests, hobbies, attributes, etc.)

Tell us why you wish to become a professional massage therapist.

I have read and understood the School Catalog.

All information given on this application is true and accurate.

I understand the refund policy.

Refund Policy

Students may cancel their application by calling the school within 3 business days of submission for a full refund of all tuition paid.
Refunds will be made within 10 business days.
Refunds for withdrawn or dismissed students are granted on a pro-rata basis calculated by the percentage of weeks of school attended. For example:
- If you are in the program 10% you will be refunded 90%.
- If you are in the program 25% you will be refunded 75%.
- If you are in the program 60%, you will not be refunded.
Students may cancel their application by calling the school within 3 business days of submission for a full refund of all tuition paid.
Refunds will be made within 10 business days.
Refunds for withdrawn or dismissed students are granted on a pro-rata basis calculated by the percentage of weeks of school attended.
Students who attend at least 60% of the program will not be granted a refund.
The portion of the tuition for books and tables (approximately $1000) is not refundable. Students would be responsible for selling these items themselves.
Students will receive any refunds due within 40 days of dismissal or withdrawal.

$1,000 DUE BEFORE THE START OF CLASS

WSMT's Director, Manda Johnson, will reach out to set up your interview & tour. Payment options will be discussed at that time!

Applicant's Signature

Date