LEMI APPLICATION FORM

Education

If not already provided in the pre-application, please complete the following:
Major Area of Study
Please indicate what is your major are of study
If you selected, Other/Not Listed, please tell us more:
College/Vocational School Name and State:
Dates Attended
Start Date

MonthDayYear
End Date

MonthDayYear
Degree Earned
If applicable, date you passed a TOEFL English proficiency exam

MonthDayYear

Medical Clearance Form
Please download and/or print this form to be completed by your physician, which must be dated less than one year before your program start date. This must be completed as part of the application package.

Please download the following form, and upload the completed form below.
File Upload

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Accommodations and Support
Do you have any of the following? (Select all that apply)*

IEP (Individual Education Plan)504 PlanDiagnosed learning difference or disabilityMedical condition requiring accommodationNone of the abovePrefer not to disclose at this time
If you selected any of the above, please briefly describe your accommodation needs:

Essential Technical Standards
The practice of massage therapy requires specific physical capabilities.

Please review the following essential technical standards in clinical and academic settings.

Mobility and Strength
- Stand/move around a massage table for 60-90 minutes
- Apply sustained pressure with hands, forearms, and/or elbows
- Assist clients with position changes when needed
Manual Dexterity and Motor Skill
- Perform precise tissue manipulations with fingers and hands
- Maintain consistent pressure and rhythm during techniques
- Adjust technique based on client feedback
- Execute movements with sufficient physical strength, stamina, motor coordination and flexibility necessary in delivering massage therapy as instructed in the program curriculum
Sensory Awareness
- Detect tissue changes and movement through palpation and/or sense of touch to perform massage therapy
- Recognize non-verbal cues from clients and/or have vision and or hearing or hearing support sufficient for assessment necessary to deliver massage therapy and assess client needs
- Maintain spatial awareness around the treatment space
Communication
- Document sessions accurately
- Carry out the verbal and/or written communication requirements of the practice of massage therapy, including discussion of health history, providing clear instructions to clients, and reviewing treatment plans
- Effectively and professionally communicate with others via speaking, listening, and non-verbal routes.
Do you anticipate needing accommodations to meet any of these essential technical standards?*

No, I can meet these standards without accommodationYes, I would need accommodation for one or more standardsI'm not sure and would like to discuss further
If you selected "Yes" above, please explain which standards you would need accommodation for and how we might assist you:
Additional Information
Are there any other factors related to learning or physical accessibility that would be helpful for us to know?
Confidentiality Statement
Information provided in this section is confidential and protected under FERPA. It will be shared only with appropriate staff involved in evaluating and providing accommodations. Disclosure of disabilities or accommodation needs will not negatively impact your admissions decision when reasonable accommodations can be made.
I authorize LEMI to share the following information as needed for educational and administrative purposes. You may uncheck any items you do not wish to authorize:*

Academic Records (includes grade reports)Student Development/ConductStudent Accounts

References
The Family Education Rights and Privacy Act (USA) permits Living Essence Massage Institute to request, but not require, that you waive your right to inspect these references. If you elect to waive your rights of access and review, please sign your name below. Not signing does not affect your eligibility for program admission.
Signature

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Date*

MonthDayYear
Date
This application requires 2 (two) professional references of a previous employer, work colleague, professor, or teacher. An additional third reference may be included if the applicant feels this would provide a more rounded or clearer set of references. This third reference is optional, is not required, and leaving it blank will not negatively affect your admission to this program. References may not be related to applicants and applicants are required to know the reference for more than one year.
First Reference
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relation*
Second Reference
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relation*
Third Reference (Optional - Can be outside of work or academics)
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Relation

Personal Statement
Please briefly describe your interest in massage therapy and your professional goals. Fill in below or upload a document.
File Upload

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Please provide a brief description of at least one benefit you received from a professional massage therapy session from the past 12 months. Fill in below or upload a document.

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Provide the session date, and the Massage Therapist's name and contact information below.
Session Date*

MonthDayYear
Date
Massage Therapists Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Application for Admission

Personal Data

Emergency Contact

Education

Medical Clearance Form

Accommodations and Support

Essential Technical Standards

Additional Information

Confidentiality Statement

References

Personal Statement

Program Start Date Preferences

Signature

Application Fee

Next Steps

Questions?