Apply Now Apply Now NAMEFirst Name*Last Name*Email* Home PhoneCell Phone*CitizenshipUS CitizenResident AlienInternational StudentMarital StatusDivorcedMarriedSeparatedSinglePartneredOptionalGenderMaleFemaleHighest Level of EducationHS DiplomaGEDSome CollegeCollege GraduateOtherSome HSADDRESSStreet Address*City*Select State*Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingGrand Bahama IslandThe AbacosAcklins/Crooked IslandAndrosBerry IslandsBiminiCat IslandEleuthera/Harbour IslandExumasGrand Bahama IslandInaguaLong IslandMayaguanaNassau/Paradise IslandRum Cay/San SalvadorAlbertaBritish ColumbiaManitobaNew BrunswickNova ScotiaNewfoundlandNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon TerritoryZip Code*Select a campus*Select a campusArlington, TXBaltimore, MDKing of Prussia, PAMaitland, FLCromwell, CTPompano Beach, FLSt. Petersburg, FLSelect a program*Select a programMassageSkin CareMake Up ArtistryAdvanced Paramedical Skin CarePersonal Statement(Optional) - Please share with us a little about yourself, such as your work history, educational experience, and/or your reasons for wanting to pursue a career in massage therapy.licensure information.Licensure laws vary by state and Cortiva Institute does not guarantee that the credentials earned at Cortiva Institute schools will transfer outside the state in which training is offered. It is the student's responsibility to contact other states in which he or he may wish to practice to determine if the credits are applicable to that state's requirements. A license is required in most states to practice massage therapy. In the absence of state laws, local municipal ordinances may apply. In most cases, in addition to completing the training program, students must pass a state and/or national exam and pay application fees to obtain a license. Information regarding various state licensure requirements may be obtained through the Admissions or Career Services Departments. Fees for licensure and/or state examinations are established by various state boards or state agencies and are subject to change. Criminal conviction may affect a student's ability to become licensed. Students should contact the campus they wish to attend for additional information. I have read and I understand the licensure information. The information I have provided is true and correct to the best of my knowledge. I wish to have my application considered for admission. Application Date* Date Format: MM slash DD slash YYYY By submitting this form, you are giving your express written consent to receive phone calls and text messages from the Cortiva Institute at the phone number you have provided, potentially generated through automated technology. Consent is not a condition of enrollment.NameThis field is for validation purposes and should be left unchanged.