Application Form – Diploma Program | Professional Development from Body Therapy Institute and The Center for Embodied Education

NOTE: all fields are required, except for Secondary Phone

Your Full Legal Name*

First Name Last Name

Preferred Name*

Applying for the program beginning on:*

March 7, 2016
not sure as yet

Address*

Mailing Address City State Zipcode

Email*

Enter Email Confirm Email

Primary Phone*

Secondary Phone

This phone is:*

Cell
Home
Work

This phone is:

Cell
Home
Work

Sex*

Female
Male

Date of Birth*

Race/Ethnicity (required by the U.S. Department of Education)*

Marital Status*

Social Security #*

Let your answers to the following questions be thorough:

1) PURPOSE: Why do you want to attend massage therapy school, and what do you plan to do with the experience you'll gain at BTI?*

2) CAREER: List the work you've done over the past five years and job titles. This section may include taking care of family.*

3) RELATED EXPERIENCE: Describe any training or prior experience you’ve had in massage therapy or other health care practices – either through formal training, workshops, apprenticeships, or self-study. *

4) RECEIVING HANDS-ON THERAPY: Have you received professional massage therapy or bodywork before? List the type and number of sessions received in the past two years.*

5) PERSONAL RESOURCES: List three strengths or assets that you believe would help you be a great practitioner of massage therapy.*

6) CONSIDERATIONS: List any concerns or considerations where you may need additional support during the Diploma Program.*

7) LEGAL INFRACTIONS: Other than minor traffic offenses, have you ever been arrested, charged or convicted of a crime – or plead guilty or no contest to a crime? List all dates and details.*

8) HOW DID YOU GET HERE? Tell us how you discovered BTI. Also, what are the two or three top reasons you chose this school?*

9) FINANCING YOUR EDUCATION: Have you set aside funds for your investment in massage therapy training? *

Yes
No

If not, what are your plans for financing your education at BTI? (check all that may apply)*

Federal Student Aid (Pell Grants and Direct Student Loans)
Veterans Administration/G.I. Bill
Private Loan
Family or Community Support
Savings
BTI Installment Loan
Other

10) EDUCATIONAL BACKGROUND: List all institutions you attended beginning with high school, and the type of academic or professional credential earned. Include significant professional training programs. Click the "+" sign to add rows for more institutions.*

Name of School and/or Program	City & State	Dates Attended	Diploma, Degree or Certificate

Congratulations on taking the first step towards a new and rewarding career in massage therapy! Once your completed application is received by the BTI Admissions Department, you'll be contacted to set up an appointment for your School Tour and Admissions Interview.
At the end of this Interview, you'll also fill out a Health History Form and receive full details on the admissions process.

The Application Fee is $25.00, which you can pay here with your PayPal account or a Credit or Debit Card.

• If you have a PayPal account, just enter your password in the next screen, verify the payment source and click the blue "Pay" button.
• If you don't have a PayPal account, click the link at the bottom of the next screen for Pay with a debit or credit card. Enter your info, and click the "Pay" button at the end. You'll receive payment confirmation via email.

PAYMENT DETAILS | I'm paying the Application Fee by:*

PayPal Account, Credit Card or Debit Card

Application Fee: Online Payment*

Price:

Body Therapy Institute – Admissions Department
300 Southwind Road, Siler City, NC 27344
Phone: 919-663-3111, ext. 11
Email: enroll@bti.edu

Application Form – Diploma Program

Let your answers to the following questions be thorough:

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