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Certificate Program
Application 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:

  • Social security number
  • Proof of graduation from high school or GED earned
  • Contact information for emergency contact

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?

STUDENT INFORMATION

 

Social Security Number

*

First Name

 

Middle Name

*

Last Name

 

Please enter any other last name(s) on transcripts:

 

Do you have a preferred name?

MAILING ADDRESS

*

Address

 

Address Line 2

*

City

*

State

*

 Zip Code

*

Permanent country

CONTACT INFORMATION

 

Home Phone Number

*

Cell Phone Number

*

When do you prefer to be contacted?

*

E-Mail Address

*

What is your preferred method of contact?

*

Is it okay for us to text you?

*

Date of Birth (mm/dd/yyyy)

*

Gender (M/F)

 

Marital Status

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?

EMERGENCY CONTACT INFORMATION

Please provide all applicable information.

Primary Emergency Contact
*

Contact First Name

*

Contact Last Name

*
Contact Phone
*
Primary Contact Relationship
2nd Contact Information
 

Contact First Name

 

Contact Last Name

 
Contact Phone
 
Secondary Contact Relationship
*

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?

*

Citizenship Status

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?

 

Naturalization Date

 

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 Program
Texas Department of State Health Services
Mail Code 1982
P.O. Box 149347
Austin, Texas 78714-9347
E-mail: massage@dshs.texas.gov
Telephone: (512) 834-6616
Fax: (512) 834-6677
Website: http://www.dshs.texas.gov/massage

MISDEMEANOR OR FELONY CONVICTIONS

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 choose how you will fund your education.

*

Will you be requesting financial aid?

 

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?

Please explain:

 

Is medical supervision required?

Please explain:

 

Are you currently under a doctor’s care?

Please explain:

 

Are you currently taking any medication?

Please explain:

Any physical problems which may influence your effectiveness to give and/or receive massage therapy?

Please explain:

Application Certification

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)

*

Date

 
  
  
 

Application Fee Waiver Code

MyParkerPRD03