Center for Natural Wellness
School of Massage Therapy
3 Cerone Commercial Dr.
Albany, NY 12205
Application for Admissions
Please complete this application and mail to us along with a recent photograph and a $50 non-
refundable application fee (payable to the CNW School of Massage Therapy). Please read instructions
carefully and complete all questions. This application cannot be processed if questions are left
unanswered. Upon receipt of this application, we will contact you to arrange an interview. Class size
is limited and enrollment closes when classes are full. Serious applicants are encouraged to complete
their application as soon as possible.
PLEASE PRINT OR TYPE
First Name: _________________ Middle Initial: ___ Last Name__________________________
City: _________________________State: ___________Zip Code: __________________________
Home Phone: ____________________________Work Phone: _____________________________
Date of Birth (MM/DD/YY): __________________________Age: __________________________
Social Security Number: ____________________________________________________________
Are you a citizen of the U.S.?
Yes ____ No____
Have you ever been convicted of a felony or misdemeanor (excluding traffic violations)?
Yes ___ No ___If yes, please explain on a separate sheet of paper.
How did you find out about us?
Emergency Contact: - Identify two (2) people to be contacted in case of an emergency:
Home Phone (___) ___-____ Work