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To apply for admission to The Institute for Holistic Health, please fill out the form below. If you prefer to mail your application, you can download a copy of the application form here.

A $50 application fee is required when submitting an application to The Institute for Holistic Health. This may be paid on-line after you have completed your application, or it may be paid in person when you come in for your initial meeting.

DOWNLOAD APPLICATION FORM

Applicant's Personal Information

Name(Required)

First Last

Street Address(Required)

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

Cellphone(Required)

Home Phone

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Age(Required)

Are you a citizen of the U.S.?(Required)

Yes

Preferred and/or Previously Held Names

Please list all preferred and/or previously held legal names, including those that would appear on school transcripts or other admissions documents

Ethnicity

White, non-Hispanic

Black, non-Hispanic

Hispanic

Native American/Eskimo

Asian/Pacific Islander

Mixed Ethnicity

Gender

Male

Female

Unspecified

Other

Have you ever been convicted of a felony or misdemeanor (excluding traffic violations) or are there any pending charges against you?(Required)

Yes

If yes, please explain:

How did you hear about about The Institute for Holistic Health?

Which program schedule are you interested in?

Full-time

Part-time Mornings

Part-time Afternoons

Uncertain

Education

You must have either completed high school, achieved a GED or the High School Equivalency (HSE) before enrolling at The Institute for Holistic Health.

High School Name and State(Required)

Dates Attended (From/To /Year Graduated)(Required)

If not a High School Graduate, did you obtain a GED or the equivalent?

College/Vocational School Name and State

Dates Attended (From/To)

Degree Earned

Do you have any physical limitations that would prevent you from participating in the program or working as a massage therapist?(Required)

Yes

The Institute for Holistic Health can provide accommodations in the classroom for students who qualify. Please check YES or NO if you would like more information about applying for accommodations by meeting with the Educational Director.

If yes, please explain:

First Reference

Please include two professional references of a previous employer, colleague, professor, etc. References may not be related to applicants and applicants are required to know the reference for more than one year.

First Reference Name(Required)

First Last

First Reference Relation(Required)

First Reference Phone(Required)

First Reference Email(Required)

Second Reference

Second Reference Name(Required)

First Last

Second Reference Relation(Required)

Second Reference Phone(Required)

Second Reference Email(Required)

Emergency Contact

Name

First Last

Cellphone

Work Phone

Signature

I hereby state that the information provided in this application is truthful, and I understand that providing false information can result in dismissal from the program or denial of admission.

Applicant’s Full Name

Date

MM slash DD slash YYYY

Any Questions?

Call us at 845-475-0010 or email us at hello@massageschoolny.com

Our program is registered by the New York State Education Department