Massage Therapy Certificate Program Application for Admission 2013

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Massage Therapy Certificate Program Admission Application Page 1 of 7 Updated May 9, 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.

P

LEASE 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.

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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: ________________________________________________________________________

______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

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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

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MASSAGE THERAPY CERTIFICATE PROGRAM ENROLLMENT CONTRACT

PLEASEREADANDSIGNTHESECONDPAGETOINDICATETHATYOUUNDERSTANDANDAGREETOTHESE TERMS,REQUIREMENTS,ANDREGULATIONS.YOURSIGNATUREONTHENEXTPAGEINDICATESTHATYOU

UNDERSTANDANDAGREETOTHESETERMS.

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.

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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.

______________________________________ __________________________________________ __________________

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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,

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Massage Therapy Certificate Program Application for Admission 2013