Application for
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 2016. 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.
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 08362. 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.
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 08362. 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___________________________ Email__________________________________
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.
Address_______________________________________________________________________ Phone (___)_______________________________________ Email_____________________ Relationship to Applicant _________________________________________________________ Name___________________________________________ Title/Position___________________ Address_______________________________________________________________________ Phone (___)_______________________________________ Email_____________________ 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________
Statement of Interest
Please explain why you wish to work in the health care industry as a Massage Therapist:
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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.
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
Dates Applied
Arm / Device / Antigen / Manufacturer / / /
Date Read Results (mm)
_____________________________________ ________________________________ Signature of Examiner Print Name of Examiner
______________________________________________________________________________ Address
_____________________________________ ________________________________ City State Zip Date
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
