Please print, complete and send this form with required documents
and application fee to the address below.

Application Form
Shiatsu School of Canada 455 Spadina Ave., Suite 300  Toronto, Ontario M5S 2G8
Telephone:  (416) 323-1818  or  Toll free:  (800) 263-1703 (USA & Canada only)

Program applying to: ____________________________________

Preferred start date: ____________________________________

Personal Data: (Please Print)


Name:  ________________________________________  / ________________________ / ____                
            
(last)                                                                             (first)                                       (initial)

date of birth:  _____ / _____ / _____     age:  _____             
                              day       mth       yr

 address:  _________________________________________________________________
                                          street

__________________________________  _______________________________  ___________________
city                                                                 province                                                  Postal Code


Email address:  _____________________________________________
                                         

phone: (CELL) ____________________________  (OTHER)  _______________________________  

NEXT OF KIN:  ___________________________________   relationship:  _______________________

ADDRESS:  ____________________________________________________________________________

_____________________________________________________________________________________

FAMILY PHYSICIAN:  ____________________________________________________________________
                                   name

______________________________________________________________________________________
address

Illnesses  Within the Past Year: ___________  from _______  to   _______

PRESENT OCCUPATION:

_____________________________________________________________________________________
Company Name / Location / Phone

________________________________________________________________
Position/Title                                                                                                 Duration

 PAST WORK EXPERIENCE:  

_____________________________________________________________________________________
Company Name / Location / Phone

________________________________________________________________
Position/Title                                                                                                 Duration


POST- SECONDARY EDUCATIONAL:

School Name / Location                                     Program / Course             Length of Study    Year Graduated

____________________________________  ____________________  ______________  _____________

____________________________________  ____________________  ______________  _____________

  

TUITION PAYMENT PLANS:  I plan to pay:  (check one)

In full  Yes ____  No ____

In Instalments:  Yes___  No ____

Note:  Payments can be  made by cash, certified cheque or money order, and in Canadian funds only.  There is a late charge of $10 per day ($50.00 per week), on overdue accounts.

DOCUMENTATION REQUIRED:
The following documents must accompany your application.  Check if included in your application.  If not included, indicate date it will be available.

  • complete application form ___
  • application fee of $25 ___
  • proof of high school diploma or GED (General Educational Development Test) by providing transcripts*
    OR transcripts from any post secondary educational institution; does NOT need to be related to your desired program(s) of study *Transcripts must be sent directly to the school from the issuing institution to be official.
    ___
  • completed medical letter from your family physician indicating that you are in good physical and general health, that you are free from communicable diseases and your tuberculosis status within the last year ___

DOCUMENTATION REQUIRED FOR INTERVIEW: PLEASE PRESENT THE ORIGINAL FOLLOWING IDENTIFICATION DOCUMENTS

  • photo identification (e.g. driver's license, passport or age of majority card) ___
  • birth certificate ___  *from your country or province
  • Social Insurance card ___ *if applicable (if applying for OSAP)

NOTE:  The school reserves the right to cancel or change start dates of program if there is insufficient enrolment.  Should the program be cancelled, the applicant will receive a complete refund for their registration fees and/or tuition.


The Shiatsu School of Canada reserves the right to make changes to any course, program, fee, policy or procedure with respect to availability, delivery mode, schedules, or course requirements described in this calendar, at any time, without further notice.

Copyright.  The Shiatsu School of Canada Inc. This website may not be reproduced or copied in whole or in part without the express written consent of the Shiatsu School of Canada Inc.