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.

Applicant Information
Name*
First Middle Last Maiden Name
Address*
Street / APT# City ZIP Code
Preferred Name*
Driver's Licence #*
Last 4 of Social Security #*
Date of Birth*
MM slash DD slash YYYY
Email Address*
Cell Phone Number*
Work Phone Number
Emergency Contact Information
Emergency Contact Name*
First Name Last Name
Relationship to Applicant*
Contact's Phone Number*
Education & Employment Information
Are you a high school graduate or equivalent?*
Documentation Available?*
- Yes
- No
Highest Level of Education*
Name of School / GED*
Current Occupation*
Preferred Class Options
Preferred Weekday Schedule*
- Daytime Classes
- Evening Classes
- Both Day & Evening
Preferred School Start*
- Spring
- Summer
- Fall
Preferred Tuition Payment*
- Prepaid
- Payment Plan
- Financial Aid
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
- No
Criminal History
Have you ever been convicted of a felony or a misdemeanor (other than minor traffic violation)?*
- Yes
- No
If yes, please explain*
Note - A prior conviction may result in denial of State Licensing as a massage therapist.
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
These questions must be answered with a minimum of three to five complete sentences.
How do you intend to use your massage training?*
Why are you interested in Irene's school?*
What characteristics do you have that will be useful for a massage therapist?*
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*
MM slash DD slash YYYY
Applicant Background
The following section is optional. The information in the section is used for federal reporting. Irene’s Myomassology Institute is an equal opportunity educational facility and does not discriminate against applicants based on this or any other information.
Ethnicity
Race
Citizenship
Other*
Other*
Payment
$25.00 Admissions Application Payment
Name On Card*
Billing Zip Code*
Credit Card Number*
Security Code*
Hidden
Expiration Date
MM slash DD slash YYYY
Expiration Date*
Please enter a number less than or equal to 9999.

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Application for Admission

Applicant Information

Emergency Contact Information

Education & Employment Information

Preferred Class Options

Criminal History

Essay Questions

Refund Policy

Applicant Background

Payment

About Irene’s

Education

Careers

Highlights

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