Center for Neurosomatic Studies Application for Admission

The Neurosomatic Therapy and Massage program at CNS prepares students for licensure in Massage Therapy and Personal Training. Learn about the admission requirements. You can also submit your application by mail by downloading it as a PDF. An application fee of $100 is required with submission. All fields are required.

General Information:

First Name:
Middle Initial:
Last Name:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:
Email:
Date of Birth:

Education Information:

Select the highest grade completed in each category.

High School:
Graduation Date:
GED Attained
Name and Address of School:
College:
Graduation Date:
Degree Attained:
Name and Address of College:
Additional Education Information, Name of Institution and Field of Study:

Employment Information:

Name and Address of Current Employer:
Name and Address of Previous Employer:

Emergency Contact:

Name:
Relationship:
Phone:
Alternative Phone:

Pre-Interview Questions:

How did you hear about us?
What are your short and long-term goals?
Tell us about yourself, your interests, attributes, hobbies, etc.
Have you been convicted of a crime (other than a minor traffic violation) in the last 15 years? If so, explain:
Why do you want to be a Neurosomatic Therapist?
How do you plan to finance your education?
How soon would you like to start training?

Signature:

By signing this application electronically, you are certifying that the information provided above is true and accurate to the best of your knowledge.

Applicant Signature:
Date Signed:

Application Fee:

CNS requires a nonrefundable application fee of $100 when you submit this application. If you wish to send a check or money order, please print and mail your application to 13825, Icot Blvd., Suite 604, Clearwater, FL33760. Application fees are refundable only in the event that you are refused acceptance at Center for Neurosomatic Studies. To pay with a credit card, please complete the information below authorizing us to charge the $100 application fee.

Card Type:
CC Number:
Card Expiration Date:
Card ID (CVV2/CID) Number:
[what is this?]
Billing Address:
Enter your billing address exactly as it appears on your credit card statement.
Use same address as above
First Name:
Last Name:
Email:
Street Address:
City:
State:
Zip Code:

Your information is held in strict privacy and will be used only within The Center for Neurosomatic Studies. You may receive occasional special offers and/or other news information and can opt out at any time.

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