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Please take a moment to complete and submit the online application below.

An application fee of $120.00 is payable at this time via e-transfer to: payments@sutherland-chan.com.

(**Account name: Sutherland-Chan Schools Inc.)

If you require assistance, contact our Admissions Coordinator by email to andrew@sutherland-chan.com.

Personal Information:

FirstName(Required)

LastName(Required)

Gender(Required)

Birth Date(Required)

Program(Required)

ExpectedStartYear

ExpectedStartMonth

Contact Info:

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone:(Required)

Home Phone:

Email:(Required)

In Case of Emergency, Please Contact:

Emergency Contact:(Required)

Emergency Contact Phone (preferred):(Required)

Emergency Contact Alternate Phone:

Educational Information:

HighSchoolName

HighSchoolCity

HighSchoolProvinceState

HighSchoolLastYearofAttendance

High School Graduation

Highest Level of Education

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Name of Post Secondary Institution

Post Secondary Program

Post Secondary Address

City State / Province / Region Country

Post Secondary Education Status:

PostSecondaryYearofAttendance

TypeofDegree

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Referral Information (If Applicable)

Referral Name:

Referral Email:

Referral Phone:

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Accuracy(Required)

I declare that all of the information provided above and in any attached documents is accurate

By submitting this form, I agree that Sutherland-Chan School of Massage Therapy may call, text and/or email me.

Welcome to Sutherland-Chan

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Educational Information:

Referral Information (If Applicable)

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