Fill out our Online Application
Fields marked with an * are required.
There is a $25.00 application fee. You will be instructed where to mail payment upon completing the application.

Personal / Contact Information
*Name:
* Social Security Number:
*Street Address:
*City:
*State:		Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
*Zip Code:
*Home Phone:
Work Phone:
Mobile Phone:
*Email Address:
How did you hear about us?		choose... Current A.N.T. Student Natural Therapy Alumni Therapist or Staff Member Professional Massage Therapist Career Counselor Another Friend or Family Member Advertisement Search Engine Other
Availability
During which hours are you available for courses and/or clinic hours?
*	Class/Clinic Hours:	Clinic Hours:
	Weekday Mornings	Weekend Mornings
	Weekday Afternoons	Weekend Afternoons
	Weekday Evenings	Weekend Evenings
Person to Notify in Case of Emergency
*Name:
*Street Address:
*City:
*State:		Choose a State Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
*Zip Code:
*Home Phone:
Work Phone:
Mobile Phone:
Email Address:
Student Housing Information
I will make my own housing arrangements/I don't need housing assistance.
I would like to explore student housing options/I need housing arrangements.
Monthly Rent:
Number of Roommates:
Smoking Preference:		choose... Smoking Non-Smoking
Post-Secondary Educational Experience
*High School Attended:
School 1 Attended:
Dates:
Area of Study:
Degree Earned:
School 2 Attended:
Dates:
Area of Study:
Degree Earned:
Please list any additional training/vocational/occupational schools:
List any previous experience in massage therapy or other healing arts:
Please list any hobbies/interests/skills:
Employment History
Employer:
Street Address:
City, State, Zip:
Contact Name & Phone:
Dates of Employment:
Job Title:
Duties:
Employer:
Street Address:
City, State, Zip:
Contact Name & Phone:
Dates of Employment:
Job Title:
Duties:
Acceptance Questions
Please answer the following questions to the best of your ability. Be creative and detailed in your answers. Please write at least 2-3 sentences.
1. Please explain how the study of massage is an appropriate career path for you and how it relates to your plans for the future.
2. Discuss your responses and feelings about receiving feedback.
3. Give examples of life changes you have made or will make that will be necessary in order to complete your academic obligations.
4. Compose a personal statement with additional information you feel would be helpful to the admissions committee in reviewing your application.
Personal History
In complieance with ADA Laws, do you wish to declare a disability in which you shall need an accommodation? Yes      No If Yes, please explain:
Are you fluent in the English language?		Yes      No
Do you have the ability to stand for 45 minutes?		Yes      No
In your opinion, do you think you are physically capable of performing massage therapy?		Yes      No
Are you over 18 years of age?		Yes      No
Have you ever been convicted of a felony?		Yes      No
If Yes, please explain:
Any additional information you feel would be helpful to the admissions committee?
Our Policy
It is the policy of this organization to provide equal opportunities withour regard to race, color, religion, national origin, gender, sexual preference, age or disability. Thank you for completing this application form and for your interest in the Academy of Natural Therapy.
Agreement and Signature
By submitting this application, I affirm that the facts set forth are true and complete. I understand that if I am accepted as a student, and false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. Aditionally, I authorize the Academy of Natural Therapy to run a complete personal criminal and background check. I have read the above agreement and agree to be bound by its terms.
Signature:
Please digitally "sign" the above application form by filling in your full name preceeded and followed by slash (/) symbols, followed by your email address as entered above. For example, a valid 'signature' would be "/Your Name/ myemail@myemailaddress.com"
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