Please complete a copy of the application shown below.  Mail or fax your application to our
Williamsburg location.  You may also email your application as an attachment to us at:  
Americanspiritinstitute@yahoo.com  
                            American Spirit Institute
                                    360 McLaws Circle
                            Williamsburg, VA 23185
                               Phone: (757) 220-8000
                    Williamsburg Fax: (757) 220-9122
Stanardsville - (434) 985- 9857     Richmond - (804) 822-1558
                            Application for Admission                                                                                      
     A $50.00 Application Fee Must Accompany This Application

Name:______________________________________________________________________

Address:__________________________________________________________________

Phone:____________________________________________________________________

Phone Alternate:___________________________________________________________

Email Address: _______________________________________________

Social Security Number:___________________________________________________

Date of Birth:______________________________________________________________

In Case of Emergency Notify:_______________________________________________

Contacts Address:________________________________________________________

Contacts Phone:__________________________________________________________

Formal Education: Circle Level Completed
High School: 1 2 3 4   College: 1 2 3 4   Vocational: 1 2 3 4     Graduate: 1 2 3 4

High School Attended:                                Graduation Date:

College:                                                          Graduation Date:

Other :                                                             Graduation Date:

Please list previous experience in massage, Esthetics , or other related professions:





Please list 2 personal references:
1.Name:
Address:
Phone:
Years Known:
__________________________________________________________
2.Name:
Address:
Phone:
Years Known:
___________________________________________________________
Employment History:
Please Begin with most recent employment:
1.Employer Name:
City/State:
From:                To:
__________________________________________________________
2.Employer Name:
City/State:
From:               To:
__________________________________________________________
3.Employer Name:
City/State:
From:              To:

Have you been treated for any medical condition other then colds or minor injuries in the last
five years? ____________ If yes, explain

Have you ever been convicted if a felon or misdemeanor other than a traffic offense? _________
If yes, explain:

Please describe what your professional goals, and how you hope to use this training?


Please list planned start date:              Month:                         Year:

Class time preferred:             Daytime or Evening

Program for which you are applying : ______________
Please list your preference of payment: (Circle one)     Pay in full       or     Payment Plan

By signing this form I also state that to the best of my knowledge I am free of communicable               
disease, in good health, and physically able to practice in this field. I also affirm that I have read the
school's catalogue.  I understand and will comply with the policies stated therein.                         
Please state any problem  contrary to the above paragraph.


Signature: _________________________     Date:__________
If possible, please attach a small recent photo of yourself to this application. Thank you.
Application