New Inspirit School of Healing Arts Online Application

Inspirit School of Healing Arts

7575 Kingspointe Parkway Suite #21, Orlando, FL 32819

Inspirit School of Healing Arts Online Application

First Name

Last Name

Cell Phone

Street

City

State/Province

Zip/Postcode

Birth Date

Social Security No

Program

Payment Method

Current Employment

Name of Employer

Employer Phone

Position/Title

Length of Employment

Education

Last Attended Academic Institution

Institution Address

Year of Graduation

The Registration Fee must accompany these additional requirements:

Valid driver’s license or Government ID

High School Diploma, GED or Transcripts

Background Check Notification

Agree

Criminal Background Disclosure: I am fully aware that I may not be able to obtain a massage therapy license by the State of Florida if I have criminal background.

Payment Information

Items	Amount
Tuition	$0.00
Total	$0.00

Payment Method

Required

Phone Number

Required

CardHolder Name

Required

CardHolderID / RIF

Required

Credit Card Number

Required

Expiration Date

Required

Security Code

Required

Currency

USD

Account Number

Required

Routing Number

Required

I state that the information provided on this application is true. I understand that any false information contained here will be grounds for dismissal from the program.

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