Massaged Life & Wellness Academy

Application for Admission

Complete this Application Form and Submit
Upload the required items or mail to:

Massaged Life & Wellness Academy
3518 Loop Road, Tuscaloosa, AL 35404
Tel. +1 205-248-7416
E-mail. mlwacademy@gmail.com

Your Personal Information

Name *

Address *

City

State

Zip

Current Employment *

Job Title

Employment Address

City

State

Zip

Emergency Contact *

Relationship

Phone

Date *

Birth Date *

Age

Gender

Prefered Pronouns

Primary Phone *

Work Phone

Your Email *

How were you originally referred to Massaged Life & Wellness Academy? *

Please Upload an image of Your State/government Issued Photo ID *

Choose File

Education

High School *

City

State

Year of Graduation

GED

City

State

Year Received

College/University

Degree

Year

Field

College/University

Degree

Year

Field

Please Uploaded a of Copy of High School or College Diploma/Transcripts, or GED *

Choose File

Medical History

(If you answer yes to any of the medical history questions, a physician’s release may be required.)

History of any serious Medical Problems? If yes, describe the nature of the illness *

Do you have any muscle/skeletal injuries or communicable diseases? If yes, please explain: *

Is medical supervision required? If yes, please explain *

Are you currently under a doctors care? If yes, please explain: *

Are you currently taking any medication? If yes, please list: *

Any physical limitations that might inhibit your ability to learn in a classroom environment that includes giving and/or receiving massage therapy, observing demonstrations, seeing the blackboard/whiteboards and television, and listening to lectures? If yes, please explain: *

Any sight or hearing problems? If yes, please explain: *

Legal History

(If you answer yes to any of the questions under Legal History, please schedule an appointment with the School Director to discuss your eligibility for licensure before applying for the Program.)

1. Have you ever been convicted of, or entered a plea of guilty of nolo contendere, regardless of adjudication, to a felony? If yes, please explain: *

2. Has it been more than 15 years prior to the date of this application since the sentence and completion of any subsequent period of probation for such conviction? *

Personal References

Please list information for two references other than family. One reference can be the same as your letter of recommendation.

1. Name *

Daytime Phone *

Address

State

Relationship *

Evening Phone

City

Zip

2. Name *

Daytime Phone *

Address

State

Relationship

Evening Phone

City

Zip

Please Uploaded 2 Letters of Recommendation that are Current and Addressed to MLWA

Choose File

Admission Short Answer Essays

The purpose of this phase of the application process is for us to get to know each other, using a short essay format. The input that you put into this process will give us an idea of what we can expect of you as a student. Please provide your short answers to the following questions. The topics are Professionalism, Respect, Attire, Hygiene, Participation, Ability to give/receive massage, Study Habits, and Goals.

1. Professionalism is the essence of therapeutic massage. We believe that massage professionals are, in effect, ambassadors of the massage profession. The way we relate, speak, and behave has an effect on the profession as a whole. What do you think about professionalism as it relates to massage therapy? In other words, how do you plan to demonstrate professionalism as a massage therapist? *

2. At MLWA we believe in equality. We believe that clients, students, staff and faculty should be treated with respect - regardless of race, gender, religious beliefs, sexual orientation, physical disabilities, or personal views. We expect students to respect the teacher as the leader in the classroom and we expect students to respect each other throughout the course. What would make you feel comfortable and/or uncomfortable in the classroom? What does “respect for teachers and classmates” mean to you? *

3. Hygiene professional appearance/attire and wellness are extremely important in the practice of massage therapy. We believe that a massage therapist needs to be free from addictions and mind-altering substances (including some prescription medications). Students need to take special care in terms of personal hygiene, including the trimming of fingernails. Each student is responsible for her/his own level of wellness, including physical fitness, stress management, mental health, and spiritual wellness. Highly visible body art (tattoos) and excessive/obvious body piercing is discouraged. What are your views in regard to hygiene, professional appearance/attire, and wellness—as they relate to massage therapy? *

4. We at the MLWA, believe that participation is an extremely important part of the classroom experience. We expect everyone to participate fully in every class. Lack of participation (absence, sickness, injury, fatigue) may have an adverse effect on a student’s grade. Every student is expected to participate in classroom activities (e.g. stretching, observation of demonstrations, hand-on practice, etc.). What are your thoughts about classroom participation? Include your views on punctuality /timeliness. *

5. Our students need to be able to hear the instructor, and need to be able to see the materials that we use for education. Each student needs to be able to stand, push, lift, and pull as part of practicing massage. Each student needs to be able to give and receive massage - meaning that a student cannot have contraindications to receiving massage treatment. In addition, a student needs to be able to apply sound body mechanics techniques while administering massage. Do you have any physical limitations that might inhibit your ability to learn in a classroom environment that emphasizes hand-on practice and use demonstrations, overhead projections, blackboard/whiteboards, television, and audio? *