Massage Training Program Application Packet

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Massage School Program Approval, Re-Approval, orApprenticeship Application PacketContents:1. 676-124. Contents List and Mailing Information.1 page2. 676-125. Application Instructions.2 pages3. 676-126. Massage School Program/Apprenticeship Standards.6 pages4. 676-127. Massage School Program Approval, Re-Approval,or Apprenticeship Application.2 pages5. 676-117. Table of Contents.3 pages6. 676-128. Massage Program Courses Offered Form.1 page7. 676-138. Instructor/Trainer Resume.1 page8. RCW/WAC and Online Website Links.1 pageIn order to process your request:Mail your application andother documents to:Board of MassageTraining ProgramP.O. Box 47877Olympia, WA 98504-7877Contact us:360-236-4700DOH 676-124 September 2021

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Application Instructions ChecklistAll information should be printed clearly in blue or black ink. You will be notified in writing of anyoutstanding documentation needed to complete the process.Use the following checklist to help guide you through the application.FF Select the type of application you are applying for on the first page of the application: First time approval of Massage School/Program Re-approval of Massage School/Program First time approval of Massage Apprenticeship Program Re-approval of Massage Apprenticeship ProgramFF Legal Entity Type: check your legal owner/operator business structure type according to yourWashington State Master Business License. Additional information is on theDepartment of Revenue website.FF 1. Demographic Information:Uniform Business Identifier Number (UBI number): Enter your Washington state UBI number.All Washington State businesses must have UBI numberss. City, county, and state governmentdepartments also have UBI numbers.Federal ID Number (FEIN number): Enter your Federal ID Number, if the business has beenissued one.Legal Owner/Operator Name: Enter the owner’s name as it appears on the UBI/MasterBusiness License.Mailing Address: Enter the owner’s complete mailing address.Phone, Fax and Cell Numbers: Enter the owner’s phone, cell, and fax numbers.Email and Web Address: Enter the owner’s email and facility Web addresses, if applicable.Facility/Agency Name: Enter the facility’s name as advertised on signs, brochures, or Web site.Physical Address: Enter the facility’s physical street location including city, state, ZIP code, andcounty.Phone, Fax and Cell Numbers: Enter the facility’s phone, cell, and fax numbers.Mailing Address: Enter the facility’s mailing address, if different from the physical address.Authorized Representative Name: Enter the facility’s authorized representative’s name.Authorized Representative Phone and Email: Enter the authorized representatives email andphone.FF 2. Accreditation Information:List if your school or program is accredited and provide attachments.FF 3. Program Information:Provide the requested information about the program offered.FF 4. Program Representative Attestation:The authorized program representative must sign and date this application.DOH 676-125 September 2021 Page 1 of 2

Additional InformationThe principal responsibility of the Board of Massage is to safeguard the public’s health and safety byensuring that licensed massage therapists are qualified to perform therapeutic massage, and that theschools or apprenticeship programs where they study will provide the education they need to do so.The Board comprises four licensed massage therapists and one member of the general public.The process for considering your application is as follows: The application is assigned and sent to two reviewing board members (RBMs) fortheir review and evaluation. At the next board meeting, the two RBMs will summarize their findings and makea recommendation. The Board then votes to approve, or send a list of additionalinformation needed, or deficiencies to remedy, or deny the application. Approval means that applicants for a massage therapy license who graduate fromthe school during the school’s approval period will be eligible to take the massagelicensing examination. A deficiency letter means the Board requires additional information from the schoolprior to program approval. When an applicant sends additional information, the Board reconsiders theapplication at a future Board meeting.All completed massage school program or apprenticeship program application packets must besubmitted in triplicate, separated into three ring binders, and contain the following: Completed massage school program/apprenticeship program application packet. Completed Table of Contents Supporting documents for each standard listed in the Table of Contents must haveconsecutive page numbers and be separated and tabbed as follows:-- Standard One: Curriculum Tab 1-- Standard Two: Academic Standards Tab 2-- Standard Three: Faculty Tab 3-- Standard Four: Student Clinic and/or Externships Tab 4-- Standard Five: Health, Sanitation and Facilities Tab 5-- Standard Six: Professional Conduct Tab 6-- Standard Seven: Records Tab 7-- Standard Eight: Eligibility Tab 8 Labeled photographs of the following:-- Exterior of the building in which the school operates,-- The classroom, and-- Any other area used for student clinic.Schools accredited by the Commission on Massage Therapy Accreditation (COMTA):In addition to the above requirements, COMTA-accredited schools must submit proof of currentaccreditation. COMTA accreditation must reconcile to the program year(s) in which Board approvalis being requested. Example: Massage School 1 is seeking board approval for its 500-hour programthat took place in 2004 to 2006. COMTA accreditation needs to be for the 2004 to 2006, 500-hourmassage program.The Board may conduct a site review. To ensure continued compliance, periodic follow-up sitereviews may be conducted by the Board.DOH 676-125 September 2021 Page 2 of 2

Massage School Program/Apprenticeship StandardsThe Board of Massage uses the following standards and requires supporting documentation to evaluate aschool/apprenticeship program’s eligibility for approval:To expedite the application process, read the instructions carefully. Please submit an application that iscomplete and easy to review. The following standards, required documentation list and checklist are consistentwith the items Board members use to review applications.Use the following checklist to ensure that all documents are submitted.FF Completed application formFF Is the program COMTA approved?(COMTA approved programs are not required to submit information regardingevidence of standards 2, 5, 6, 7, or 8)FF Attestation signed by an authorized representativeFF Completed Massage Program Courses Offered formFF Completed Table of Contents formStandard One—CurriculumThe curriculum shall be designed and presented to meet or exceed the minimum requirements in WAC 246830-430 that will be effective on September 1, 2021. An hour of training is defined as 50 minutes of actualinstruction time.Standard One – Required Documentation:The application must show what courses are being taught to meet or exceed the above requirements. Becausenot all schools’ curricula are designed precisely along the lines of Washington’s requirements, the applicantmust list all courses offered within the massage program on form 676-128 (Massage Program CoursesOffered) and submit a syllabus for each course taught. It is vital that reviewing board members (RBMs) areable to reconcile the required hours between the syllabi and the “Courses Offered” list. The application may bereturned to the applicant for clarification or additional information if this information is not provided.A. Massage Program Courses Offered form: The applicant must list all courses taught in the programand not just those that satisfy Washington’s minimum requirements. The grand total hours of all coursesoffered must be the same as the total number of hours listed on Page 1 of the Massage School ProgramApplication.B. Course syllabi (one for each course offered) must include the following: Course title Subject matter per WAC 246-830-430 that will be effective Septembe 1, 2021 Course hours Instructor(s) name(s) Student competencies to be accomplished in the form of measurable objectives for thecourse (using terms such as “demonstrate, identify, locate” rather than “understand,recognize, evaluate”) Methods of evaluation Course schedule (must include course dates and times) Textbooks and other instructional materials usedC. Sample or samples of mid-term, final, or other equivalent exams for each of the following subjects: Anatomy and physiology Pathology KinesiologyDOH 676-126 September 2021 Page 1 of 6

D.E. Practicum criteria Ethics and professionalism Laws and rules pertaining to massageStatement regarding how a student will obtain first aid and CPR trainingInstitutional philosophy or mission statementStandard One Checklist – Curriculum (hours expressed as minimums)FF Massage Program Courses Offered form-- 90 hours of anatomy and physiology to include the following: --orientation to the human body, and the integumentary, skeletal, fascial, muscular, nervous,cardiovascular and other body systems60 hours or more of kinesiology to include the following: muscle identification and palpation, location and attachment(s), actions, range of motion, andjoint classification and function--70 hours of pathology to include the following: general terminology and classification of diseases, the indications, contraindications,cautions and common adaptations to massage including, but not limited to, arthritis, bursitis,cancer, headaches, skin cancer and other skin conditions, diabetes, fasciitis, sprain, strain,tendinopathy, nerve compression syndromes, osteoporosis, stress, fibromyalgia and otherchronic pain syndromes, common neurological diseases, autoimmune disorders, bloodbornepathogens, common cardiovascular diseases, reproductive systems, pregnancy, and anyother health care issues as they relate to the practice of massage as defined in RCW18.108.010--260 hours of massage theory, principles, and practice of massage to include the following: history of massage, benefits and effects, techniques and strokes, body mechanics of thetherapist, application methods and styles, concepts of basic research, session planning andthe adaptation of techniques appropriate to stages of healing, to include the safe use ofsuperficial heat, cold, lubricants and salts, and considerations relevant to special populations--50 hours of student clinic (75 hours maximum for programs beyond 625 hours) that is: directly supervised as defined in WAC 246-830-005(9) and in accordance with WAC 246830-420(1)(d) a ratio of no less than one instructor to no more than six students who are actively performingmassage--55 hours of clinical/business practices to include the following: hygiene, sanitation, draping, recordkeeping, billing and insurance concepts, medicalterminology, business models and management, and laws and rules relevant to massage andmassage businesses--40 hours of professional ethics to include the following: the therapeutic relationship of the massage therapist and client or patient, human behavior,communication skills, professional boundaries, standards of ethical practice, and state lawsand rules related to massage and health care ethics.--Do required course hours match those listed in the course syllabi?--Are all other courses listed on the Massage Program Courses Offered form?--Do all course hours total program hours listed on page 1 of the application?--An explanation has been provided for discrepancies between all course hours and total programhours listed on page 1 of the application.DOH 676-126 September 2021 Page 2 of 6

FF Course syllabi (one for each course offered)FF Sample or samples of mit-term, final, or other equivalent exams for each of the following subjects:-- Anatomy and physiology--Pathology--Kinesiology--Practicum criteria--Ethics and professionalism--Laws and rules pertaining to massageFF Statement on how a student will obtain first aid and CPR trainingFF Institutional philosophy or mission statementStandard Two – Academic StandardsThe massage school program instructors or apprenticeship trainer will regularly evaluate the quality of theinstruction, and provide students with expected competence and progress standards. Schools, programs, andapprenticeship trainers shall not discriminate on the basis of sex, gender, race, age, color, religion, sexualorientation, gender expression, physical handicap, national or ethnic origin or other basis prohibited by law inthe recruitment of students or in the hiring of faculty.Each successful phase of the program and graduation from the program is dependent on the student’sproficiency of the knowledge and skills presented. Standard Two documentation is not required if the school isaccredited by Commission on Massage Therapy Accreditation (COMTA).Standard Two – Required DocumentationA.B.A statement or policy on minimum standards for measuring student progressCopies of policies and procedures for: Admission (How do you determine who to admit?) Progression (How is learning measured and how do students progress through the program?) Graduation Withdrawal Dismissal (What are the corrective measures when a student is found not to be meetingminimum standards?) NondiscriminationStandard Two Checklist – Academic Standards (not required if COMTAapproved)FF A statement or policy on minimum standards for measuring student progressFF Copies of policies and procedures for:-- Admission (how do you determine who to admit?)-- Progression (how is learning measured and how do students progress through the program?)-- Graduation-- Withdrawal-- Dismissal (what are the corrective measures when a student is found not to be meeting minimumstandards?)-- NondiscriminationDOH 676-126 September 2021 Page 3 of 6

Standard Three—Faculty:Massage school program instructors or, an apprenticeship program trainer are required to be qualified bytraining and experience to provide effective instruction in the subjects they are teaching. They are required todevelop and evaluate curriculum instruction methods and facilities; student discipline, welfare, and counseling;assist in the establishment of administrative and educational policies; and provide for a student’s scholarly andprofessional growth.Standard Three – Required Documentation:A.B.C.D.A policy for ensuring minimum competency standards for instructors and a statement that all massageschool, massage program or apprenticeship program instructors meet those standards (not necessary forapprenticeship programs)A statement or policy describing faculty members’ participation in curriculum development and evaluation(not necessary for apprenticeship programs)A resumé for each instructor or trainer (template provided below)A listing of all courses each instructor or trainer plans to teach/instruct.Standard Three Checklist—FacultyFFFFFFFFPolicy on minimum competency standards for instructorsStatement or policy on faculty members’ participation in curriculum development and evaluationResumés for each instructor or trainer (template provided below)A listing of all courses each instructor or trainer plans to teachStandard Four—Student ClinicAll clinical facilities are required to be adequate in size and resources for students to practice massage on thegeneral public. All rooms used for consultations, massage therapy or treatment are required to be properlyequipped with the resources needed to practice clinical hygiene procedures.A faculty member who is a massage therapist with at least three-years of experience in massage therapy mustprovide direct supervision as a clinical supervisor and makes final decisions on the massage therapy that isrendered to a client by a student. A faculty member in the role of a clinical supervisor must ensure a ratio of noless than one faculty member to no more than six students who are actively performing massage.Standard Four—Required Documentation:A.B.C.D.E.F.G.A statement that the student clinic is supervised by a faculty member who is a Washington State licensedmassage therapist with at least three years of experience in massage therapyA statement that the faculty to student ratio in the student clinic is no less than one faculty member to nomore than six students who are actively performing massagePolicies pertaining to the clinical supervisors:-- review of the health history of the student’s client--review and approval of the student’s massage plant--observation of a reasonable portion of each massage session based on the competency of thestudentDisclosure statement form provided to clientsClient intake and screening formClient feedback formSupervisor feedback formDOH 676-126 September 2021 Page 4 of 6

Standard Four Checklist—Student ClinicFF A statement that the student clinic is supervised by a faculty member who is a Washingtonstate-licensed massage therapist with at least three years of experience in massage therapyFF A statement that the faculty-to-student ratio in the student clinic is no less than one faculty member tono more than six students who are actively performing massageFF Policies pertaining to the clinical supervisors: review of the health history of the student’s client review and approval of the student’s massage plan observation of a reasonable portion of each massage session based on the competency ofthe studentFFFFFFFFDisclosure statement form provided to clientsClient intake and screening formClient feedback formSupervisor feedback formStandard Five -- Health, Sanitation, and FacilitiesAll programs will have adequate facilities and equipment available for students learning massagetherapy. All facility equipment will be maintained according to local rules and ordinances governinghealth and sanitation. Instruction and practice equipment shall be similar to that commonly found ina professional practice. An adequate reference library, appropriate to the subjects being taught isrequired. Standard Five documentation is not required if the school is accredited by COMTA.Standard Five—Required Documentation:A.B.C.D.E.F.A statement that facilities are maintained in accordance with state and local ordinances and rulesgoverning health and sanitationDetailed floor plan of the facility (dimensions required), include labeled photographFloor plan of student clinic (dimensions required), include labeled photographList of equipment available to students in the classroomList of equipment available to students in the clinicList of library contents and computer or online resourcesStandard Five Checklist—Health, Sanitation, and Facilities (not required ifCOMTA approved):FF A statement that facilities are maintained in accordance with state and local ordinances and rulesgoverning health and sanitationFF Detailed floor plan of the facility (dimensions and facility photo required)FF Floor plan of student clinic (dimensions and student clinic photo required)FF List of equipment available to students in the classroomFF List of equipment available to students in student clinicFF List of library contents and computer or online resourcesDOH 676-126 September 2021 Page 5 of 6

Standard Six—Professional ConductApproved educational programs will follow professional standards. Students will be taught and will consistentlypractice professional draping techniques. Students will be fully clothed while giving a massage. Classroomnudity is prohibited. Students will be taught to professionally respond to client requests. Standard Sixdocumentation is not required if the school is accredited by COMTA.Standard Six—Required DocumentationCopies of policies that outline faculty and student conduct, as stated in Standard Six, above.Standard Six Checklist—Professional Conduct (not required if COMTA approved)FF Policies on faculty and student conductStandard Seven—RecordsRecords must be stored in a secured location and be made available upon a student’s written request. Theprogram transcript must provide adequate information to conclude that the student has successfully completedthe approved educational program.Standard Seven——Required DocumentationA.B.Sample transcriptPolicy on release of student records consistent with applicable law(s)Standard Seven Checklist—Records (not required if COMTA approved)FF Sample transcriptFF Policy on release of student records consistent with applicable law(s)Standard Eight—EligibilityWashington massage schools must be eligible to operate under one of the following options: Is approved to operate in the state of Washington by the workforce training and educationcoordinating board, or Is licensed by private vocational education, or Is part of a college or university that is nationally or regionally accredited.This section is not applicable to an apprenticeship program unless more than one apprentice is in training atany given time. In Washington, if a trainer would like to enter into an apprenticeship agreement with more thanone student at any given time, he or she must first become certified as a private vocational school throughWorkforce Training and Education Coordinating Board. Please contact its office by phone at: 360-709-4600.Please submit a copy of the certificate of approval to this program.Standard Eight—Required DocumentationCopy of the certificate of approval to operate this program.Standard Eight Checklist—Eligibility (not required if COMTA approved)FF Copy of Washington State Workforce Training Education Coordinating Board Certificate, orFF Verification that the school is licensed by private vocational education (see chapter 28C.10 RCW orTitle 28B RCW), orFF Verification that the program is part of a college or university that is nationally or regionallyaccredited.DOH 676-126 September 2021 Page 6 of 6

DateStampHereMassage School Program or Apprenticeship ApplicationApplication for: c New Massage School/Programc Re-approval Massage School/ProgramLegal Entity Typec New Apprenticeship Programc Re-approval of Apprenticeship Program Association Limited Partnership Sole Proprietor Corporation Municipality (City) State Government Agency Federal Government Agency Municipality (County) Tribal Government Agency Limited Liability Company Non-Profit Corporation Trust Limited Liability Partnership Partnership1. Demographic InformationUBI numberFederal Tax ID (FEIN) numberLegal Owner/Operator NameMailing AddressCityStateZIP CodeCountySchool or Program Name (Business name as advertised on signs or Web site)Physical AddressCityPhone (enter 10-digit number)StateZIP CodeCell (enter 10-digit number)CountyFax (enter 10-digit number)Mailing AddressCityContact EmailStateZIP CodeCountyProgram/apprenticeship Web AddressAuthorized Representative NameAuthorized Representative EmailAuthorized Representative PhoneDOH 676-127 September 2021 Page 1 of 2

2. Accreditation InformationIs your school approved by the Commission on Massage Therapy Accreditation (COMTA) or does your school holdany other federally approved accreditations?c Yes c NoIf yes, please list them. Attach copies of documentation verifying accreditation, including the agency’s name,address and date accreditation was issued.3. Program Information:Provide the following information about the program offered.Program TitleLength of ProgramWeeksHoursName of Certificate offeredMaximum faculty to student ratioIn classroomIn student clinic or externship4. Program Representative Attestation:I attest that I am the authorized representative of the above-named school or program, and that I am submitting thisapplication for approval by the Washington State Board of Massage in that capacity. I have become familiar with thelaws relating to Massage Therapists in chapter 18.108 RCW and chapter 246-830 WAC.I have reviewed the board’s standards for approval and understand that this application will not be considered bythe board if it is incomplete. I understand that a future site visit may be required. Once approved, any modification(s)to the program must be reported to the board within 30 days of the modification per WAC 246-830-420(5)(c).Name of Authorized RepresentativeTitleSignature of Authorized RepresentativeDate (mm/dd/yyyy)DOH 676-127 September 2021 Page 2 of 2

Massage CredentialingP.O. Box 47877Olympia, WA 98504-7877360-236-4700Massage School Program or Apprenticeship ApplicationTable of ContentsApplication—Complete the Department of Health ApplicationPage 1Standard 1: CurriculumTab 1A.Massage Program Courses offered SpreadsheetPageB.Course syllabi (one for each course offered) must include the following: Course title Subject matter per requirements in WAC 246-830-430 effectiveSeptember 1, 2021 Course hours Instructor(s) name(s) Student competencies to be accomplished in the form of measurableobjectives for the course (using terms such as “demonstrate, identify,locate”, rather than “understand, recognize, evaluate.”) Methods of evaluation Course schedule (must include course dates and times) Textbooks and other instructional materials usedPageC.Sample or samples of mid-term, final, or other equivalent exams for each of thefollowing: Anatomy and physiology Pathology Kinesiology Practicum criteria Ethics and professionalism Laws and rules pertaining to massagePageD.A statement regarding how a student will obtain First Aid and CPR training; toinclude training standards and number of hours requiredPageE.Institutional philosophy or mission statementPageStandard 2: Academic StandardsTab 2A.PageA statement or policy defining the minimum standards for measuring studentprogressDOH 676-117 September 2021 Page 1 of 3

B.Copies of policies and procedures for: Admission (Hour do you determine who to admit?) Progression (How is learning measured and how do students progress throughthe program?) Graduation Withdrawal Dismissal (What are the corrective measures when a student is found not to bemeeting minimum standards?) NondiscriminationPageStandard 3: FacultyTab 3A.Policy on minimum competency standards for instructors and a statement that all massageschool, massage program or apprenticeship program instructors meet those standardsPageB.A statement or policy on faculty members’ participation in curriculum development andevaluationPageC.A resumé for each instructor or trainer (template provided)PageD.A listing of all courses each instructor or trainer plans to teachPageStandard 4: Student ClinicTab 4A.A statement that the student clinic is supervised by a faculty member who is a WashingtonPagestate licensed massage therapist with at least three-years of experience in massage therapyB.A statement that the faculty to student ratio in the student clinic is no less than one facultymember to no more than six students who are actively performing massagePageC.Policies regarding: review of the health history of the student's clientPage review and approval of the student's massage plan observation of a reasonable portion of each massage session based on thecompetency of the studentD.Disclosure statement form provided to clientsPageE.Client intake and screening formPageF.Client feedback formPageG.Supervisor feedback formPageStandard 5: Health, Sanitation and FacilitiesTab 5A.A statement that facilities are maintained in accordance with state and local ordinances andrules governing health and sanitationPageB.Detailed floor plan of the facility (dimensions and facility photo required)PageC.Floor plan of student clinic (dimensions and student clinic photo required)PageDOH 676-117 September 2021 Page 2 of 3

D.List of equipment available to students in the classroomPageE.List of equipment available in the student clinic, if offeredPageF.List of library contents and computer or online resourcesPageStandard 6: Professional ConductTab 6A.PagePolicies on faculty and student conductStandard 7: RecordsTab 7A.Sample transcriptPageB.Policy on release of student records consistent with applicable law(s)PageStandard 8: Eligibility--Copy of Washington State Workforce Training and Education Coordinating BoardCertificate, or--Verification that the school is licensed by private vocational education, or--Verification that the program is part of a college or university that is nationally orregionally accreditedTab 8PageDOH 676-117 September 2021 Page 3 of 3

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Massage Program Courses OfferedBoard of MassagePO Box 47852Olympia, WA 98504-7852360-236-4700Hours expressed in minimumAttach additional sheets if necessaryName of school/programTotal Program HoursSchool LocationSubject AreaWAC 246-830-430Anatomy &Physiology(90 Hours)Course TitlePageNumberKinesiologyPathologyTheory &(60 Hours)(70 Hours)PracticeCourse Hours Course Hours(260 Hours)Course HoursCourse HoursStudentClinic(50 min to75 max)Course HoursClinical/BusinessPractices(55 Hours)Course HoursProfessional All otherEthicscourses(40 Hours)Course HoursCOURSETOTAL(mustmatchsyllabus)Course HoursSubject Area TotalDOH 676-128 September 2021

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Massage CredentialingPO Box 47877Olympia, WA 98504-7877360-236-4700Instructor/Trainer ResumeA separate resume must be submitted for each instructor/trainer.Instructor name:Professional License InformationLicense number:Original issuance date:School, Work History, and Continuing Education *SchoolWork HistoryContinuing Education Courses* You need to list only information relevant to the courses that will be tau

other health care issues as they relate to the practice of massage as defined in RCW 18.108.010 - 260 hours of massage theory, principles, and practice of massage to include the following: history of massage, benefits a

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