Aloha Institute of Massage and Healing Arts
Application Form for Admittance
Please print this form, fill it out and send it to us with
your $100 application fee.
Please make fee payable to AIMHA (Aloha Institute of Massage and Healing Arts).
We will contact you to discuss your admittance. If you have questions,
you may call us at: (808) 263-2468.
Please
mail to:
AIMHA
22 Oneawa St. Unit-F
Kailua, HI. 96734
Full
Name: _____________________________________________________________
Address:Ý ______________________________________________________________
City, State, Zip: _________________________________________________________
Best phone # to contact you at: _____________________ Other: _________________
What time is best to reach you: ____________________________________________
E-Mail: _____________________________________________
Birthday: ___ / ___ / ______
SOC: _____- ____- _______
Place of birth (for International Students):
_________________________________________
Visa Status: _________________ Visa Number: ___________________________________
Which semester are you applying for:Ý January, May or Sept. / Year:
200___
How will you pay your tuition:
__________________________________________________
Current Profession: _____________________________
Educational
Background:
School: _____________________ Degree: ____________________ Date: _________
School: _____________________ Degree: ____________________ Date: _________
School: _____________________ Degree: ____________________ Date: _________
Describe your experience or training in any type of massage therapy or health
care modalities?
____________________________________________________________________________
_____________________________________________________________________________
What leads you to a career in massage
therapy at this time?
____________________________________________________________________________
_____________________________________________________________________________
How did you hear about our school?
____________________________________________________________________________
In particular, what qualities are guiding you to choose
The Aloha Institute of Massage and Healing Arts-HI over other massage schools?Ý
____________________________________________________________________________
____________________________________________________________________________
Please give a
brief autobiography and statement as to why you have selected Massage
Therapy as a profession:
Ý___________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
What are your long range career plans?
____________________________________________________________________________
____________________________________________________________________________
Do you have
any concerns about completing this program?
____________________________________________________________________________
____________________________________________________________________________
Explain all current and recent illnesses and injuries
(physical, mental, emotional) and any
medications you are presently taking.
_____________________________________________________________________________
_____________________________________________________________________________
Explain any habitual use of drugs,
including alcohol, tobacco, caffeine, or sugar?
_____________________________________________________________________________
______________________________________________________________________________
If you have served in the U.S. Armed Forces, give
branch of service and approximate dates
of military service: Branch _________________ Dates _____________________
Have you ever been convicted of a serious crime (felony)? If yes, please
explain.
__________________________________________________________________________
Character Reference:
Full Name: _____________________________________________
Phone number to contact: _________________________________
Relationship: ____________________________________________
How long have you known this person: _______________________
Emergency Contact:
Full Name: ______________________________________________
Relationship: ____________________________________________
Where or how did you hear about AIMHA?: _________________________________
The above information is true to the best of my knowledge:
Signature: _______________________________________ Date:
_______________________