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Name *

First

Last

Prior Name (if applicable)

First

Last

Pronouns *

Please specify your pronouns

Phone Number *

Date of Birth *

Email *

Program Applying For: *

9 Month 700 Hour Massage Training Program (begins September)
12-month 700 Hour Night Program (begins April)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Program Start Date *

How did you hear about ASHA? *

Emergency Contact Information

Name *

Relationship *

Phone *

Education History

High School or GED Testing Center Name *

Graduation/GED Date *

(You must be a HS graduate or its equivalent to apply to ASHA)

College Education

Have you completed any degrees, trainings, or certificates? *

Name of School *

(Include college, university, and vocational schools. List most recent training first)

Location *

Degree Awarded *

Dates Attended *

Name of School

(Include college, university, and vocational schools. List most recent training first)

Location

Degree Awarded

Dates Attended

Name of School

(Include college, university, and vocational schools. List most recent training first)

Location

Degree Awarded

Dates Attended

Have you ever been expelled /dismissed from an educational institution? *

If yes, please explain *

Employment History

Are you currently employed? *

Current Employer *

Employer's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Start Date *

Will you continue working while attending ASHA? *

Do you have previous work experience of any kind? *

Previous Employer *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Start Date *

End Date *

Reason for Leaving *

Medical History

Do you have any medical conditions that may influence your ability to complete your massage therapy training or that may affect you in the future as a massage practitioner? (These conditions may include, but are not limited to: surgeries, injuries, diseases or psychological disorders.) *

If Yes, ASHA will require medical documentation and a doctor or psychiatrist’s release stating your fitness for undertaking a program of this nature.

Please describe any conditions referenced above. Use a separate sheet of paper if necessary: *

Do you have any learning differences that we should be aware of to help ensure your success in ASHA’s training program? *

If yes, please explain: *

Have you ever received behavioral health services or learning accommodations? *

If yes, please explain: *

**It is the responsibility of the applicant to self identify any past or current health issues, behavioral health services received, or learning accommodations received. We will not discriminate or deny admission based on this information. It is, however, required that all pertinent medical, behavioral health, and past learning accommodations be disclosed before enrollment at ASHA can proceed. Withholding this information could negatively impact your success and/or jeopardize your continued enrollment in our program and your ability to obtain a NM State Massage Therapy license. Any cost for services required to meet your learning accommodations while a student at ASHA will be the applicant’s responsibility.

Are you currently taking any medications? *

This includes medical marijuana prescriptions.

Please list any medications you are currently taking, this includes medically prescribed marijuana: *

Are you pregnant? *

Yes
No
Not applicable to me

If yes, expected date of delivery: *

Criminal History

Have you ever been convicted of a felony or misdemeanor other than traffic offenses? *

If yes, please explain the situation to the best of your ability. Please note: This information is confidential and will not necessarily hinder you from receiving a New Mexico State massage license. *

Massage Therapy licensure requires background checks. If you agree to attend ASHA as a massage therapy student, do you agree to a background check? *

Comments:

Personal References

Name of Personal Reference *

Relationship *

Phone Number *

Background

We’d like to get to know you and learn about your background. Please answer the following questions in either essay or short answer format.

1. What are your personal and professional goals for your ASHA training program? *

2. This course requires students to evaluate, observe, and work into the deeper self. How well do you work through your own emotions, feelings, and judgements? *

3. What is your background with massage and/or the healing arts? If you’ve been trained in other modalities we’d love to know about that. *

4. Have you ever received a professional massage? If so, please tell us about a massage that you received in the last year or two. Describe the environment of the session and tell us about your experience of the massage in terms of its effect on your body, state of mind and emotional response. *

5. What drew you to pursue massage therapy as a profession and the ASHA Holistic Massage Therapy training program in particular? *

ASHA Admission Requirements

Must submit formal application packet
Must successfully pass entrance interview
Must receive an ASHA School Tour (live or virtual)
Must be 18 years of age
Must hold a High School Diploma or GED equivalent
Applicants are evaluated without discrimination on the basis of age, gender, race ethnic origin, creed, sexual preference or disability

Upload your photo ID here

Drag & Drop Files, Choose Files to Upload

Application Checklist:

I have attached a copy of my photo ID
I have included an application fee of $100.00. Checks payable to ASHA
I have signed this form

Please note: The fee associated with this application is non-refundable. If a student is accepted and enrolled, the fee will be applied toward tuition. An ASHA representative will call to schedule a school interview when all completed application materials have been received.

In signing this form, 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 ASHA 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 Albuquerque School of Healing Arts.

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 prior to the application deadline.

Signature *

Clear Signature

Application Fee *

Price: $100.00