Steps Steele Pilates Teacher Certification Program Application Checklist (International Students)

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Steps’ Steele Pilates Teacher Certification Program Application Checklist

(International Students)

Items to be included in your Application Packet*

:

□

Completed application checklist

□

Completed application form

□

Letter of introduction detailing the type of Pilates you have been studying (if any), the number of years you have been

studying, and any current certifications you may have. Please also describe any dance training you have had and the

number of years you have been studying. Please describe your future goals in the dance/fitness industry.

□

Dance and Fitness resume (if any)

□

One passport sized photograph

□

One photo in a dance or fitness pose that highlights your technique

□

Health Form

□

Copy of Current Passport

□

Financial documentation proving funding for tuition and living expenses. Please refer to International Student Guide

for acceptable forms of documentation

□

Non-refundable $200 application fee payable by bank transfer, credit card, money order, or travelers checks in U.S.

dollars. Cash is not accepted.



For bank transfer - JP Morgan Chase 2099 Broadway New York, NY 10023;

Account # 771178944

Routing # 021000021. Please include an additional $28 for bank fees

.



Credit cards - American Express, MasterCard or Visa only.

* - Incomplete application packets will not be accepted

________________________________________________________________________________________________

Acceptance

Within two weeks of receiving your completed application, Steps on Broadway will notify you by email of your

acceptance.

____________________________________________________________________________

Items to be sent After Acceptance:

Fifty percent (50%) of the tuition is due within ten (10) days of receiving your acceptance notice. The remaining fifty

percent (50%) is due ten (10) days prior to your program start date. Non-payment will result in delay or loss of position

within the program. Payments plans are based upon financial need on an individual basis.

All rates are subject to change.

__________________________________________________________________________________________________________

Mailing address:

Steps on Broadway

Professional Training Programs

2121 Broadway @ 74

th

Street, Third Floor

New York, NY 10023

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Steps’ Steele Pilates Teacher Certification Program Application Form

(International Students)

First NameLast Name___

EmailPhone__

Address in Home Country __________________________________________________________________________

Street

______________________________________________________________________________________________________________________

City State Postal Code Country

Address in New York (if established)___________________________________________________________________

Street

______________________________________________________________________________________________________________________

City State Zip

□

Male

□

Female

Date of Birth__//_

Native Language________________________

Month Day Year

Country of Birth___ Country of Citizenship_

Current Certifications (if none, write none)______________________________________________________________

Passport Number_ Expiration Date____

I WOULD LIKE TO ENROLL IN (students may select both sessions):

□

Mat Certification (October 1, 2014—December 31, 2014)

Application deadline August 1, 2014

□

Advance Certification (January 1, 2015—March 31, ,2015)

Application deadline November 1, 2014

Enclose a check for the Application Fee of $200.00 made payable to

Steps on Broadway

Credit Card:

□

American Express

□

MasterCard

□

Visa

Name on Credit Card__________________________________________________________________________

Number___________________________________Expiration Date_

How did you hear about this program?___________________________________________________________________________

I hereby represent that I am over eighteen (18) years of age

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PROFESIONAL TRAINING PROGRAM HEALTH FORM

I. STUDENT INFORMATION

Name

_______________________________________________________________________________

(Please Print)

Phone Number ____________ Date of Birth

(Month/Day/Year)

Emergency Contact ____________________________________________________________________

Relationship to Student Phone Number

_____________________________________________________________________________________

II. HEALTH INSURANCE INFORMATION

(Please note that health insurance is required for all PTP students)

Do you currently have health insurance coverage?

Yes

If

yes

: Insurance Company _____________ Dates of Coverage _

(Please include a copy of your health insurance card or other proof of insurance with this application)

No

, please send me information about Steps’ Group Health Plan (International Students Only)

No

, I plan to find coverage prior to enrollment and will provide proof of insurance at orientation.

_____________________________________________________________________________________

III. MEDICAL HISTORY

Do you have any medical conditions that we should be made aware of?

Yes

No

If

yes

, please list the medical condition(s):

_________________________________________________________________________________

Is there any other information regarding your condition(s) that you would like us to know?

____________________________________________________________________________________________

___________________________________________________________________________________________

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III. MEDICAL HISTORY (continued)

Do you take any medications?

Yes

No

If

yes

, please list all medications:

_

Do you have any allergies?

Yes

No

If

yes

, please list all allergies:

_

Please list any physical and/or dance related problems you have including injuries, bone, joint or muscular

disorders, etc.

____________________________________________________________________________________________

Permission to Dispense Non-Aspirin Medication

:

By company policy, Steps Studio Inc. staff will not administer

any medication without your prior authorization. If you authorize staff to dispense a

non-aspirin

pain reliever

product (i.e., Tylenol) please read below.

For cases of headache and/or minor aches or pains, Steps Studio Inc. has my permission to administer a

non-aspirin pain reliever product.

If you do not authorize Steps Studio Inc. to dispense medication do not sign below and initial here

_________________________ _

(Student Signature) (Date)

ACKNOWLEDGEMENT

I do hereby state that, to the best of my knowledge and belief, the medical history I have provided is correct

and accurate. I agree to report, in a timely manner, injuries and/or conditions that are pre-existing or have

occurred while participating in the Professional Training Program (PTP). I understand my medical history is

confidential under state and/or federal laws and that Steps Studio Inc. staff will not release to anyone or

discuss with anyone outside of the company, unless separately authorized by me or required or permitted by

law.

I authorize Steps Studio Inc. to speak in their sole discretion with any Hospital Representative and/or Medical

Provider about injuries, illnesses, treatment and rehabilitation that may affect my ability to participate in the

PTP and/or any injury suffered during my participation in an activity associated with PTP.

My signature below acknowledges that I understand and agree to the terms above.

_________________________ _

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International Student Application Guide

Financial Support*

To be accepted to Steps on Broadway, international students must have sufficient funding for both school tuition and living expenses for the duration of their program.

All documents must be in English and currency in US dollars. Students must prove an amount greater than or equal to: Independent Study Program



$7,500 for a 3 month period



$26,000 for a 12 month period 2-Year Conservatory Program



$32,500 for a 12 month period (students planning to stay in New York during summer break) Steps’ Steele Pilates Teacher Certification Program



The following documents are acceptable forms of financial support:



Official Bank Statement-The statement must be on bank letterhead and in the name of the applicant or sponsor.



Official Bank Letter-The letter must be on bank letterhead and confirm a balance equal to or in excess of the

tui-tion and living expenses for the expected length of studies.



Official Proof of Income or Employment of Family Member-A letter, paycheck stub, or annual income tax

return from a family member proving employment and ability to provide for your tuition and living expenses. Fami-ly member must prove an amount greater or equal to double the monthFami-ly tuition/living expenses of the student.



Affidavit of Support– If the statement, letter or proof of income is in the name of any individual other than the

applicant, the sponsor must provide a letter stating that they are willing to support the applicant for the duration of their course of study.



Official Award Letter-If the applicant is receiving a government or institutional scholarship, grant, or loan, please

submit the award letter. The award letter must state the amount and duration of the scholarship, grant or loan and must specify if the funds are renewable on an annual basis. If the award does not cover the total cost of tuition, fees and living expenses, additional financial documentation must be enclosed.

Health Insurance

Students are expected to carry health insurance for the duration of their course of study. Students may provide proof of current health insurance or sign up for the group plan through Steps on Broadway. More information available upon re-quest.

Steps Steele Pilates Teacher Certification Program Application Checklist (International Students)