Application Form - Therapeutic Massage - CE

Application to this program is currently OPEN.

*Required - Full Name:

*Required - Date of Birth

Select from the calendar or type in your date of birth as 01/01/2000

*Required - Current Address:

*Required - City:

*Required - State:

*Required - Zipcode:

*Required - Phone:

*Required - Email:

*Required - Citizenship

US Citizen

Permanent Resident Alien

Non-Resident Alien

*Required - Name of Hight School Attended:

Daytime

Massage I - Beginning August 2023

Massage II - Beginning January 2024

Daytime Courses Mandatory Orientation/Registration: June 5, 2023 1 - 4 pm in the Health Building, Room F103

Evening

Massage I - Beginning January 2024

Massage II - Beginning May 2024

Evening Courses Mandatory Orientation/Registration: November 6, 2023 5 - 9 pm in the Health Building, Room F103

NOTE: The following items are required with the application:

A copy of your high school transcript or equivalent.
A copy of your driver's license to show proof of age (must be 18 years old or older).
Two (2) moral character forms.

The above documents can be emailed to: jcchealthadmissions@johnstoncc.edu, or drop them off on campus.

*Required - Today's Date

By submitting this form (need a disclaimer since they can't sign it. )