Application for Admission

Complete this form in its entirety to apply for Irene’s Massage Program. Submit this application with a $25 non-refundable registration fee. Your application will be reviewed by our admissions team who will be in touch reguarding your next steps.

Irene’s Myomassology Institute

"*" indicates required fields

Name*

First Name Middle Name Last Name Maiden Name

Address*

Street / APT# City ZIP Code

Preferred Name*

Driver's Licence #*

Last 4 of Social Security #*

Date of Birth*

Email Address*

Cell Phone Number*

Work Phone Number

Emergency Contact Name*

Relationship to Applicant*

Contact's Phone Number*

Are you a high school graduate or equivalent?*

Documentation Available?*

Yes

Name of High School / GED*

Highest level of education completed?*

Current Occupation*

Preferred Weekday Schedule*

Daytime Classes

Evening Classes

Both Day & Evening

Preferred School Start*

Fall

Winter

Summer

Intended Tuition Payment*

Self Paid

Financial Aid

Other

Preferred Program*

1 Year (Full time)

2 Year (Part time)

How long have you considered becoming a massage therapist?*

Approximately how many informal massages have you given to friends & family?*

Do you have a computer and internet access, necessary for homework?*

Yes

Have you ever been convicted of a felony or a misdemeanor (other than minor traffic violation)? Note - A prior conviction may result in denial of State Licensing as a massage therapist.*

Yes

If yes, please explain

I fully understand that I cannot work in the adult entertainment industry while attending Irene’s. I have no intention of using the training I receive at Irene’s to obtain employment in the adult entertainment industry in the future.*

Essay Questions

How do you intend to use your massage training? This question must be answered with a minimum of three to five complete sentences.*

Why are you interested in Irene's school? This question must be answered with a minimum of three to five complete sentences.*

What characteristics do you have that will be useful for a massage therapist? This question must be answered with a minimum of three to five complete sentences.*

Refund Policy

If an applicant is not accepted to school, all monies will be refunded. If a program is canceled after a student's enrollment, the institution will refund all monies paid by student. If, after signing a contract, an applicant requests a refund within three business days all tuition and fees paid shall be refunded. After three days, the following policy applies. The registration fee is non-refundable. If a student does not begin training, it will result in a full refund less the $25 registration fee. If a student withdraws or is dismissed from school after the first week of class through the fourth week of program, it results in a refund for all tuition less the $25 fee. Withdrawal or dismissal after the fourth week of school, but prior to 60% completion of program, will result in a pro-rated refund calculated from the portion of tuition used, plus 10% of unearned tuition for the period of training not completed. The 10% of unearned tuition will not exceed $1,000. After the fourth week of school, handling fees on payment plans are non-refundable. Students who withdraw or are dismissed after completing 60% of the program will receive no refund. Students who withdraw or are dismissed after completing 60% of the program will be obligated to pay the total contract price of the program and applicable handling fees. If, at any time during their education, a student wishes to receive credit for prior training, an application with a non-refundable $100 processing fee must be submitted. A student's tuition will be credited for any credit granted. The students' Last Date of Attendance in school is used to calculate a refund. The total number of core classes, elective hours scheduled and required clinic hours are used to calculate the percentage of the program completed. The date in which the school identifies the student is withdrawing or being dismissed is the Date of Determination. It is possible that the student will not receive a refund and may owe a balance. Any money due the student will be refunded within 30 days after withdrawal or dismissal. If the course is canceled before the session is completed, a refund agreement will be made for unearned tuition. Otherwise, an alternate session will be scheduled. The institute does not financially obligate students for periods longer than 12 months.

I hereby certify that to the best of my knowledge, the information furnished on this application is true and complete without evasion or misrepresentation. I understand that if found otherwise, it is sufficient to cause for rejection or dismissal. I authorize Irene’s to make appropriate inquiries, when necessary, to certify the accuracy of my records.

Applicant's Signature*

Date*

The following information is for Federal Reporting purposes only. Irene’s Myomassology Institute is an equal opportunity educational facility, that does not discriminate against applicants based on this or any other information.

Ethnicity

Race

Citizenship

Admissions Application Payment*

Admissions Application Payment

Price:

Credit Card

Cardholder Name

Card Details

Phone

This field is for validation purposes and should be left unchanged.

(248) 350-1400

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Application for Admission

Irene’s Myomassology Institute

Essay Questions

Refund Policy

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