Full Name

Phone *

Email *

Address

City

State

Postal code

Date of birth

Social Security Number

Emergency Contact Name & Phone Number

Highest Education Received

In the last three (3) years have you received serious or repeated disciplinary action, dismissed, suspended, from a school?

Yes

If yes, please explain

Are you currently employed?

Have you ever been convicted of a Felony or Misdemeanor?

Yes

How do you intend to pay for TUITION?

How did you hear about us?

Why do you want to become a licensed massage therapist?

MY SIGNATURE BELOW INDICATES THAT: 1. The information on this application is true and accurate to the best of my knowledge. 2. I have read and understand the Catalog and its contents, which will become part of my agreement with Basin Massage and Integrative Studies. 3. I authorize Basin Massage School & Integrative Studies or its designee to verify all information relating to my application for enrollment, including but not limited to personal, employment, school, criminal and financial information

The Basin Massage School application fee of $100 is a one‑time, non‑refundable payment that initiates your enrollment and secures your spot in the upcoming class. It covers processing your application, verifying prerequisites, and unlocks immediate access to our student welcome portal.

Application Fee $100 *

USD

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