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INFORMATION SESSIONS TAKE PLACE THE SECOND WEDNESDAY OF EVERY MONTH!

Application Package for the 2007-2009 Diploma Program in Shiatsu Therapy
For your convenience the SSC gives consent to those wishing to print a copy of this application package for the sole purpose of applying to the Shiatsu Therapy Diploma Program at the SSC. The completed application package (hard copy) however, must be mailed or delivered to the SSC with supporting documentation, fees etc. as would a standard application. Do not e-mail completed application.
If you prefer the standard application package sent to you e-mail us at info@shiatsucanada.com or call us at 1-800- 263-1703 or (416) 323-1818.

Application Procedure for the School:

1. Read over the application form and fill it out; collect all documentation; sign where indicated.

2. Mail or hand in the completed form with all documentation including the $10 application fee. If there is a particular piece of documentation missing, indicate when we may expect to receive it. All documents must be in English or translated from the original language and certified by a Notary Public (at applicant's expense).

3. We will contact you for an interview once your application has been received.

4. Once interviewed, your application is reviewed and a decision is given within 30 days.

5. Upon acceptance you will be mailed an acceptance letter and the "application for enrolment" form. You must sign this document and return it with your non-refundable registration fee ($100) to indicate your intention to come to school. Please note the date for guaranteeing your place in the class.

6. You are now set!

7. The balance of your tuition in full, or the balance of the first installment is due August 28, 2007 (cash, certified cheque or money order only; Canadian funds). You will be mailed your invoice, the textbook list and the timetable for the first semester begins.

Application Form for Diploma Program 2007/2009 Shiatsu School of Canada 547 College St. Toronto, Ontario M6G 1A9 Telephone: (416) 323-1818 or Toll free: (800) 263-1703 (USA & Canada only) Personal Data: (Please Print) Name: ________________________________________ / ________________________ / ____ (last) (first) (initial) date of birth: _____ / _____ / _____ age: _____ S.I.N. _______ / _______ / _______ day mth yr Email Address ___________________________________ citizenship: _________________________________ immigrant status: ____________________ Permanent address: _________________________________________________________________ street __________________________________ _______________________________ ___________________ city province/state postal/zip code temporary address: _________________________________________________________________ street ___________________________________ ______________________________ ___________________ city province/state postal/zip code phone (incl. area code): ___________________________ ____________________________ __________________________ permanent temporary work NEXT OF KIN: ___________________________________ relationship: _______________________ ADDRESS: ____________________________________________________________________________ _____________________________________________________________________________________ FAMILY PHYSICIAN: ____________________________________________________________________ name ______________________________________________________________________________________ address ILLNESSES: _____________________________________________________ from _______ to _______ (within the last year) WORK EXPERIENCE: last/present & previous Company Name / Location / Phone Position/Title Duration 1. ____________________________________________ _________________________ _____________ ____________________________________________ _________________________ _____________ 2. ___________________________________________ _________________________ _____________ ___________________________________________ _________________________ _____________ EDUCATIONAL BACKGROUND: HIGH SCHOOL: Grade achieved: ________ Year: ________ POST SECONDARY: (University, College, Private Vocational, Other) School Name / Location Program / Course Length of Study Year Graduated ____________________________________ ____________________ ______________ _____________ ____________________________________ ____________________ ______________ _____________ PROGRAM INFORMATION: I wish to apply for: (check one) Full Time _____ or Part Time _____ COURSE START DATE: September 11, 2006 TUITION PAYMENT PLANS: I plan to pay: (check one) In Full: $12,000 Yes ____ No ____ In Installments: $12,000 Yes___ No ____ Note: Payments made by cash, certified cheque or money order, and in Canadian funds only. There is a late charge of $50 per week ($10 per week day), on overdue accounts.

All applicants must submit:

1. Providing false information on the application form or forgery of documents, records or identifications.

2. Failing to fulfill financial obligations toward the school; including tuition, seminar fees, supplemental fees, library fines, etc.;

3. Academic failure due to unsatisfactory attendance or poor course work;

4. Cheating or plagiarism including: using someone else's words or thoughts as your own as in, for example, directly quoting from a text or paper without identifying the source, or submitting work prepared by someone else as your own; copying another person's answer to an examination question during an examination; consulting an unauthorized source such as books or notes without authorization during an examination; giving or receiving help from another student during an examination, including tests, quizzes and other forms of work; obtaining a copy or test before it is officially available; distributing a copy of an examination or test before it is officially available; distributing a copy or copies of SSC tests or exams without authorization; changing the record of any grade; misrepresenting facts in order to obtain exemptions or deferrals from course requirements including examinations, essays, projects and other assignments;

5. Misconduct - displaying behaviour which is detrimental to school, staff, instructors, students, the reputation of the school or which hinders the progress of any class;

6. Sale, possession or use of illegal drugs or alcohol in the school and/or while involved in school activities;

7. Soliciting clients for your own personal practice while in School Clinic or while attending any school function;

8. For calling or implying that your are a professional therapist;

9. For violence or abusive behaviour against any member of the SSC campus community;

10. Theft, vandalism, or non-accidental damage of SSC property;

11. Engaging in lewd, indecent, or obscene behaviour on SSC property;

12. For discrimination or harassment in any form on the basic of race, colour, place of origin, ethnic origin, citizenship, ancestry, religion, creed, sex, marital status, family status, age, disability, sexual orientation, record of offences, or being in receipt of public assistance.

Installment Payment Plans 2007/2009

In full: $12, 000 or
In installments: $12,000
1st installment: August 27, 2007
(two weeks prior to school start date)
$2000 (registration fee incl.*)
2nd installment: January 1, 2008 - $2000
3rd installment:   April 1, 2008 - $2000
4th installment: September 1, 2009 - $2000
5th installment: January 1, 2009 - $2000
6th installment: April 1 2009 - $2000

* Upon acceptance, you are required to pay a non-refundable registration fee of $100. If you have paid the registration fee already, you need pay only the balance of the first installment.

The Shiatsu School of Canada reserves the right to refuse future admission to its programs, courses, and/or services to anyone who has been expelled for any of the reasons listed previously.

I apply to the Shiatsu School of Canada and I understand the terms of this application:

________________________   ____________
Applicant's signature                                                          Date

Shiatsu School of Canada Inc.
547 College Street, Toronto, Ontario M6G 149
(416) 323-1818 Toll Free (800) 263-1703 Fax (416) 323-1681

Medical Form to be Filled out by Doctor
Please take this medical form to your doctor (M.D.) to be filled out.

Medical Form

Name:

Date:

(   ) Is the above in good health and free of communicable diseases?

Comments:

(   ) Results of T.B. Test

Comments:

Is the above named person fit, healthy and able to work with the public?

(   ) Yes           (   ) No

If No, please explain why. Thank You

____________________              ____________________
Doctor's Name (please print)                     Doctor's Signature