Admissions Requirement

Admission requirements to the Polarity Center of Syracuse Associate Polarity Practitioner Program are as follows:

 

     *Applicants must be at least 18 years of age.

     *Applicants must be in good health mentally, emotionally and physically to be able to participate in all

        aspects of the program; are physically abel to give and receive Polarity session and participate in class 

        activities.

     *Applicants must hold a high school diploma, GED or be in the process of completing one.

     *Applicants must have a personal interview.

     *Applicants must submit a general letter of recommendation concerning character and experience from a          non-family member.

 

Application for Admission 

(All material submitted are confidential)

 

 

Name____________________________________________________________________

 

Date____________________Age______________DOB_____________________________

 

Address___________________________________________________________________

 

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Home Phone____________________Work_________________Cell________________________

 

Email (optional)_________________________________________________________________

 

Emergency Contact Information:

Name__________________________________________________________Relationship________________

 

Address_________________________________________________________________________________

 

Phone___________________________________________________________________________________

 

Please List any past medical or psychological conditions including injuries and hopitalizations:

 

________________________________________________________________________________________

 

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Please list any current conditions you have including medications or nutritional supplements you are taking:

 

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Are you currently under the care of a doctor, chiroptractor, osteopath, naturopath, body-worker, acupencturist,

polarity practitioner or other health care ptractitioner?  If so, please explain.

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Please describe why you are interested in taking this program:

 

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Please describe any Complimentary and Alternative training you have taken:

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Please indicate your highest level of education obtained and list certificates received:

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What is your current profession?

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Are there any special conditions that you feel are important for us to know about you that might affect your ability to complete the training or would require special treatment during the program?

 

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Please provide the name and address of your current primary health practitioner:

 

Name___________________________________________________________________________________

 

Address_________________________________________________________________________________

 

 

Please list any information that would be necessary in the case of an emergency:

 

Name___________________________________________________________________________________

 

Address_________________________________________________________________________________

 

Please mail Application for Admission, Financial Contract, Program Contract and Confirmation Statement along with payment to:

 

Naomi Kenealy LMT, BCPP, RPE, RALC

Polarity Center of Syracuse

APP Certification Program

5397 Nichols Rd

Tully, NY 13159