Application for Enrollment

To apply, please fill out this form. You can either print it out and mail it to your selected campus with your application fee, or submit online and pay by credit card.
You will still need to mail the supporting documents.

If you have previously filled out an application, please do not submit a new one.

Location:    

I am applying for the following class:




Transfer into Associate Degree program


Address 1:
Address 2:
City:
State:
Zip Code:




Employment Status




Are you eligible for Veterans Educational Benefits?

 

EDUCATION AND BACKGROUND
(indicate name on school records if different)

Have you had an application for a health care license denied or withdrawn?

Have you ever been in litigation connected with a health care practice?
If yes, please explain:

Have you ever been convicted of a felony?

*If you have been convicted of a felony, please see the licensing section of the Student Handbook

 

HEALTH CONDITIONS
(Please attach an additional sheet if needed)

List any known medical conditions:

*If you listed a medical condition or conditions above, you are required to submit a letter from a doctor confirming the diagnosis and releasing you to participate in the program with the listed condition, in addition to your general doctor’s release.

List any physical limitations that may affect your participation in the program:

List any learning disabilities that have been diagnosed by a physician:

Do you have any allergies?

How did you first hear about Lakeside School of Massage Therapy?

Complete the additional section below only if you are applying for the Associate Degree in Massage Therapy Program:

Additional requirements for the Associate Degree Program in Massage Therapy:
  • If you are transferring into the program for the 300-level advanced courses, please provide your WI State license number:

    If you are not licensed in WI, what state are you licensed in?
  • If you are transferring into the program for the 300-level advanced courses, please give a summary of your completed continuing education:

Title of course/Instructor/# of hours/Date taken

If you are transferring into the program, please give a summary of your work experience as a massage therapist, including the average number of clients/week and length of time in practice

The following items must be submitted prior to attending orientation. Students will not be allowed to attend class until all documents are recieved:

  • Proof of high school diploma or GED/State Certificate of High School Completion.
  • Transcripts from your most recently completed high school or post-secondary education.
  • Application fee of $25 (or pay online).
  • A 300-word typed explanation of your reasons for wanting to pursue a career in massage therapy, including a description of your career goals.
  • Two letters of recommendation from someone other than a family member.
  • A letter from a primary care physician stating that the prospective student is physically and emotionally capable to participate fully in the massage therapy program.
  • Proof of receiving a professional massage.
  • Evidence of immunity to measles, mumps and rubella.
  • Negative TB skin test or other evidence that applicant is free of active tuberculosis. (Test or evidence must be current within the past year.)