Student Application
Midwest School of Massage - Omaha, NE
Student Information
Student Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Social Security #
Are you a US Citizen or Legal Resident?
Have you ever been convicted of a felony or misdemeanor (excluding traffic violations)? If yes, please explain briefly.
Please Submit your Drivers License or State ID
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How did you find out about The Midwest School of Massage?
Emergency Information
Name
First Name
Last Name
Relationship
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Background Information
Did you Graduate from High School or receive a GED?
Please Upload Your HS Diploma or GED
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Do you have any post-secondary, trade school, or professional education beyond High School? If so, please tell us about it. Don't worry, this is not a requirement.
Current/ Most Recent Employer - Name of Company, Address, Phone #, Position, Dates of Employment, and Name of Supervisor.
Work History is not a requirement to acceptance in the program. We just want to get to know you better.
Previous Employer - Name of Company, Address, Phone #, Position, Dates of Employment, and Name of Supervisor.
Work History is not a requirement to acceptance in the program. We just want to get to know you better.
Do you have any medical issues that could require special accommodations or that the instructors should be aware of? If yes, please explain?
Briefly,(a paragraph or two) tell us why you would like to become a Licensed Massage Therapist?
Class Plans
Which upcoming session are you most interested in? Spring or Fall?
What Class Time works best for you: Morning or Evening?
How do you intend to pay for the Tuition? (We have 3 options detailed on our website). Don't worry, this does not need to be a final decision and we are happy to navigate you through your options. We just want to know what you are leaning toward right now.
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