Admissions Application Request - Main Form

Program Information
Contact Information
Personal Information
Additional Information
Academic
Additional Information

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First Name
Middle Name
Last Name
Email Address
Social Security Number
Date of Birth
Gender
Are you Hispanic?
Racial Background

White

Black or African American

Asian

American Indian or Alaska Native

Hawaiian or Other Pacific Islander
Citizenship Status
Citizenship Country

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Address & Phone Number(s)
Street 1
Street 2
City
State
Zip Code Zip Code Extension
Home Phone Number Home Phone Number Area Code Home Phone Number Exchange Home Phone Number Number Home Phone Number Extension Ext:
Mobile Phone Number Mobile Phone Number Area Code Mobile Phone Number Exchange Mobile Phone Number Number Mobile Phone Number Extension Ext:
Prospective Education

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Previous Education

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Select your highest level of education:
Where did you receive your High School Diploma / GED?
If you have attended College before, please let us know where:
Utah Massage Licensing Disclosure: According to the Utah Massage Therapy Practice Act (Title 58, Chapter 47b, Utah Code Annotated) and the Utah Massage Therapist Application for Licensure: New Utah Massage License applicants are now required to undergo a fingerprint background check by the Utah Bureau of Criminal Identification and the Federal Bureau of Investigation. All applicants for admission to Myotherapy College of Utah should discuss with their Admissions Representative any concerns they may have regarding their ability to obtain licensure after graduation. By signing below, the applicant acknowledges that he/she understands the preceding information.
Choose your program:
When do you plan to start?
Are you a Veteran?
Will you be applying for Financial Aid?

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How did you first hear about MCU?
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