Application Form

PERSONAL INFORMATION

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Social Security Number(Required)

Driver's License #(Required)

Date of Birth(Required)

Upload photo of Driver's License(Required)

Accepted file types: jpg, pdf, Max. file size: 256 MB.

Allowed file types: JPG or PDF

EMERGENCY CONTACT

Emergancy Contact Name(Required)

First Last

Emergency Contact Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Emergency Contact Phone(Required)

Relationship(Required)

EDUCATION HISTORY

High School Diploma or GED (upload here)

Accepted file types: jpg, pdf, Max. file size: 256 MB.

Allowed file types: JPG or PDF

Graduation/GED Date

College Education(Required)

YES

Have you completed any degrees, trainings, or certifications?

Education Experience(Required)

Yes

Have you ever been dismissed/expelled from an educational center?

Details, if Yes

EMPLOYMENT HISTORY

Are you currently employed"(Required)

Yes

Employer Name:(Required)

Current Employer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Current Employer Phone Number(Required)

Start Date(Required)

Supervisor(Required)

Will you continue to work during your studies here at Kneaded Wellness Massage Academy?(Required)

Yes

MEDICAL HISTORY

Do you have any medical conditions that may influence your ability to complete your massage therapy training or that may affect your future as a licensed massage therapist?(Required)

Yes

Do you have any learning disabilities that we should be aware of to ensure your academic success?(Required)

Yes

Are you taking any medications?(Required)

Yes

If Yes please list:

Are you Pregnant?(Required)

Yes

CRIMINAL HISTORY & REFERENCES

Have you ever been convicted of a felony or misdemeanor other than a traffic offense(s)?(Required)

Yes

If yes please explain:(Required)

References - please upload 2 letters of reference for you. One is a personal reference and the other being a professional reference of you and your character.(Required)

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 256 MB, Max. files: 2.

AGREEMENT

I certify that the statements I have made in this application are complete and true to the best of my knowledge. I acknowledge that it is my responsibility to be Aware of all pertinent admission and application requirements and I have been provided with the entire application packet required by Kneaded Wellness Massage Academy for admission into its program. I acknowledge that failure to disclose complete and accurate information, or failure to submit all required application materials may result in the denial of admission or subsequent dismissal from Kneaded Wellness Massage Academy. I understand that my application is incomplete without my signature below and that , in order to be considered, my complete application must be signed and submitted with the application fee.

By checking the box I agree to the above statements and information(Required)

I Agree

PROGRAM SELECTION & PAYMENT

SELECT THE PROGRAM YOU ARE APPLYING FOR:(Required)

Cohort 5 - Day Program (September 8, 2026 - February 13, 2027)

APPLICATION FEE(Required)

Price:

A $500 non-refundable fee is due upon submission of this application.

Credit Card

Cardholder Name

Card Details

PERSONAL INFORMATION

EMERGENCY CONTACT

EDUCATION HISTORY

EMPLOYMENT HISTORY

MEDICAL HISTORY

CRIMINAL HISTORY & REFERENCES

AGREEMENT

PROGRAM SELECTION & PAYMENT

Thank you for applying. We will be in touch to guide you through the remaining process.