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Certificate ProgramApplication for Admission
The following application is for students interested in our certificate program. This application will remain active for one year.
This application includes questions on: personal data, background, education, and interests. You must complete all sections before the application can be submitted for review by the admissions department. It should take between 15-30 minutes to complete the application once you have the necessary information including:
ENTRANCE YEAR AND TERM
Please Note: Classes begin the last week of the previous month selected (ex: If Sept is selected, your classes begin the last week of August.)
I am applying for entrance in the following year and term:
Choose a program of study:
What year do you want to start?
What term are you applying for?
Default Type of Candy
Social Security Number
Please enter any other last name(s) on transcripts:
Do you have a preferred name?
Address Line 2
Home Phone Number
Cell Phone Number
When do you prefer to be contacted?
What is your preferred method of contact?
Is it okay for us to text you?
Default Full Time Part Time
Date of Birth (mm/dd/yyyy)
Are you Hispanic or Latino?
Select one or more of the following races:
Are you an employee of Parker University?
Is your spouse an employee of Parker University?
Is your father/mother an alumnus of our school?
Is your father/mother an employee of our school?
Please provide all applicable information.
Contact First Name
Contact Last Name
Are you currently on active duty?
Are you an United States veteran?
For what branch of the military are you a veteran?
For what branch of the military are you currently serving?
The following questions are applicable to foreign students only. Supporting documentation will be required.
Are you here on a visa?
What type of visa is it?
Alien registration number
Are you naturalized?
Do you have an I-20?
Are you eligible for U.S. federal loans?
Have you taken the TOEFL test with a score of 550 (paper based) or 213 (computer based) or better?
MISDEMEANOR OR FELONY CONVICTIONS
A student’s ability to participate in an internship, clinical or fieldwork rotation may be impacted by misdemeanor or felony convictions. Applicants should familiarize themselves with the laws of the states in which they wish to practice by visiting one of the professional affiliation websites (www.abmp.org or www.amta.com). Applicants must disclose arrest and conviction records on the application for admission. Failure to disclose arrests or convictions may result in penalties up to and including dismissal from Parker University.
Please note: A graduate’s ability to obtain a massage therapy license may be impacted by misdemeanor or felony convictions. For more information please contact the Texas Department of State Health Services Massage Therapy Licensing Program at:
Massage Therapy Licensing ProgramTexas Department of State Health ServicesMail Code 1982P.O. Box 149347Austin, Texas 78714-9347E-mail: firstname.lastname@example.orgTelephone: (512) 834-6616Fax: (512) 834-6677Website: http://www.dshs.texas.gov/massage
Please note: A student’s ability to participate in an internship, clinical or fieldwork rotation may be impacted by misdemeanor or felony convictions. A graduate’s ability to obtain a professional license in allied health may be impacted by misdemeanor or felony convictions. Applicants should familiarize themselves with the laws of the states in which they wish to practice by visiting individual state board websites. Applicants must disclose arrest and conviction records on the application for admission. Failure to disclose arrests or convictions may result in penalties up to and including dismissal from Parker University.
A felony conviction may affect a graduate’s ability to sit for the national licensure examination. Students that have a criminal background SHOULD apply to the ARRT to get a pre- application packet in order to see if the ARRT is going to allow the student to sit for the Registry.
Have you ever been charged with a criminal misdemeanor/felony offense?
Please explain all charges or convictions.
Please choose how you will fund your education.
Will you be requesting financial aid?
Will you be using military benefits to pay for your education?
Do you have a high school diploma or GED?
High School Attended:
If High School not listed above please enter name:
High School Graduation Date (mm/dd/yyyy)
Name of GED Testing Center
GED Test Date (mm/dd/yyyy)
GED Testing Center City
GED Testing Center State
If you answer yes to any of the medical history questions, a physicians release may be required.
Do you have a history of any serious medical problems?
Please describe the nature of the illness:
Do you have any muscle or skeletal injuries or communicable diseases?
Is medical supervision required?
Are you currently under a doctor’s care?
Are you currently taking any medication?
Any physical problems which may influence your effectiveness to give and/or receive massage therapy?
I certify that the information given on this application is true and complete. I understand that any false information presented in, or information omitted from this application may result in my being denied admission or dismissed from Parker University, or may pose difficulty in obtaining state licensure. (Individual states and provinces establish and interpret rules for licensure. For that reason, admission to or graduation from Parker University does not guarantee that a student will meet licensure requirements in any particular jurisdiction. For further clarification, please contact the board of examiners for the jurisdiction that interests you.)
By signing and submitting this application, I acknowledge that I have read and agree to the terms of the application certification.
Signature (please type name)
Application Fee Waiver Code