Our Invitation & Enrollment Application

Our Invitation

Human Touch can and does make a difference in the lives of many people. Healing Mountain was founded on the premise that without that humanistic approach to education in the field of massage therapy, something vital is lost in the learning process.

We invite you to experience the power of this approach to touch for yourself. Get a massage from our student interns. Sit in on a class. Speak with any of our qualified staff. We'd love to assist you in making a decision that's right for you and your future. Please call us with any questions.

After all, it's your life ... your money ... and your choice.

Student Enrollment Application

Please fill out the enrollment application form online by entering your application information below.

If you'd prefer to print out the form to mail it in, you can download the enrollment application here: Enrollment Application (.pdf 430 KB)

Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Email Address

Are you a U.S. citizen? (required)

Yes
No

If not, indicate country of origin, visa or immigration status, and number

Enrollment & Financial Aid Information

For which program(s) are you interested in enrolling?

Massage Therapy
Full-time Day
Full-time Evening
Continuing Education / Temporary

For which term do you wish to enroll? (morning/afternoon 8 months)

January
July

(evening 10 months)

April
September

Please list your reason(s) for wanting to attend massage school.

Previous Schooling

GED Certificate
High School Certificate
State Approved Home School (HS diploma)
2 Year College Degree
4 Year College Degree or Higher

Date Received

Name of School

City & State

Please list any physical, mental, or medical challenges or special needs that we should be aware of (include medications being taken & conditions they're being taken for)

Signature
I hereby affirm that all statements and answers on this application and attached support documents pertaining to this application are true and accurate.
I also understand that falsification and/or omission of facts pertaining to this application and attached support documents is grounds for dismissal from school.
I authorize background checks and/or random drug testing to be made by the school for the safety of other students, teachers, and administrative school staff.
Please type your name below to indicate signature.

Signature Date

Admission Determination Criteria

Applicant is 18 yrs of age, or will be 18 yrs of age as of the estimated date of graduation.

Applicant has a minimum of an HS diploma or GED certificate. (Required, initial below)

* If English is not the applicant's primary language, are they highly proficient (hear, speak, and write in English for exams)?

Yes
No

* Do you currently have an ALCOHOL and/or DRUG ADDICTION / usage problem that has not been properly and thoroughly resolved through a supervised 12-step rehabilitation program?

Yes
No

If yes, please explain

* Are you now or have you at any time been under investigation, or is any disciplinary action pending or has any judgement been handed down against you by ANY PROFESSIONAL LICENSING AGENCY?
(i.e., licensure denial, revoked, suspended, probation, conditioned, curtailed, limited, restricted, etc.?)

Yes
No

If yes, please explain

* Is there any action pending against you now, or have you ever been charged or pled guilty to, no contest to, or have you ever been convicted of any misdemeanor or felony by any federal or state agency that could possibly affect a LICENSE TO TOUCH OTHERS (any form of sexually-oriented behavior sexual or physical abuse or violence or endangerment, etc)?

Yes
No

If yes, please explain

* "While Healing Mountain Massage School affirms its policy of freely acknowledging students who want to change their lives for the better by coming to school to learn therapeutic massage, we also affirm our position that students who practice any form of massage, bodywork, body rub, or touch-related technique or modality for money outside the safety of our school clinic without first having a license to do so, or break any law are putting themselves at risk of dismissal from school."
I have read and understand Healing Mountain's policy as stated above. (initial below)

* "As a student of Healing Mountain Massage School, students agree to abide the laws and administrative rules contained within the Utah massage Therapy Practice Act (Title 58-47b), the Utah Massage Therapy Practice Act Rules (R156-47b), and Utah Massage Therapy Code of Ethics and Professional Standards; including but not limited to those regarding unlawful conduct as defined in (58-47b-501). any violation would result in dismissal from school."
I have read and understand Healing Mountain's policy as stated above. (initial below)

Student Signature
Please type your name below to indicate signature.

Signature Date

Page updated: 04/18/24