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New Mexico Regulation and Licensing Department
BOARDS AND COMMISSIONS DIVISION
Massage Therapy Board
T on ey An a ya Bu i ld in g ▪ 2550 Cerr i llos Ro ad ▪ Sa nt a Fe, N ew Mex ico 87505
( 505) 476 -4870 ▪ Fax (505) 476 -4645 ▪ www.r ld .st at e.nm.u s/m as sa ge
MASSAGE THERAPY SCHOOL 2008 RENEWAL APPLICATION
Your school registration renewal is due on October 31, 2008.
INSTRUCTIONS
This renewal application must be legibly printed in black ink or filled in using your computer. To fill in
the fields using your word processor, enter information in the gray boxes and tab to move from field
to field.
This renewal application must be completed in its entirety and accompanied by all supporting
documentation before it will be sent to the Board for approval. Incomplete renewal applications will
be returned for completion.
It is your responsibility to ensure that the completed application is returned to the Board office before
the deadline, October 31, 2008.
This completed applications, required documentation, and fees must be postmarked or hand-
delivered to the Board office on or before the renewal date to avoid incurring a late penalty fee.
Complete renewal applications post-marked or hand-delivered after the renewal date, and prior to
December 30, 2008, must be submitted with the renewal fee, plus the late penalty fee listed above.
Registrations not renewed on or before the grace period ending December 30, 2008, will be
automatically placed on EXPIRED status without further notification from the Board.
Registrants who desire to renew an EXPIRED registration must make application to the Board and
comply with the same requirements as any previously unregistered applicant.
Schools with a non-renewed registration may not operate either during the grace period or after
(Section 12 of Part 12 16.7.12 NMAC).
Grace Period Ends: 12/31/2008 Renewal Fee: $ 50.00
License Number: Late Renewal Penalty Fee: $ 75.00
SECTION A - SCHOOL INFORMATION
NAME OF SCHOOL
MAILING ADDRESS
PHYSICAL ADDRESS - - No. & Street
CITY STATE ZIP CODE
NAME OF SCHOOL DIRECTOR CONTACT PERSON
PHONE E-MAIL WEBSITE
SECTION B – CURRICULUM
The information outlined in the following section is to be provided for programs offered for the period of November 1 of the current year to
October 31st of the following year. The outline for the entire curriculum is required in this Section. The curriculum for each program must
be no less than 650 hours. The information outlined and requested in this Section is to be provided for EACH program offered, including
day, evening, and weekend program. Therefore, this Section may be copied for each program to be offered. Each program must have a
separate calendar. You may offer more courses and hours than the requirements outlined in the Massage Therapy Practice Act and its
rules, but NOT LESS. The program CANNOT include continuing education training, life experience, experience gained through
employment related to the program, or training provided by a Visiting Massage Therapy Instructor. Note: Hours MUST be specified for
EACH item listed in this Section that your school provides instruction in its curriculum.
Revision date: 09/2008
Massage Therapy Board
MASSAGE THERAPY SCHOOL 2008 RENEWAL APPLICATION
SECTION B – CURRICULUM – Program No.: of
Hours: Hours:
ANATOMY & PHYSIOLOGY (Min. 165 hours.): Theory Practice GENERAL INSTRUCTION (Min. 75 hours.): Theory Practice
Anatomy Hydrotherapy
Physiology Business
Kinesiology Professional Ethics (to include 16.7.2 NMAC)
Pathology First Aid
Other (List): Cardio Pulmonary Resuscitation (CPR)
Other (List):
Sub Total: Sub Total:
Theory & Practice Total: Theory & Practice Total:
Hours: Hours:
MASSAGE THERAPY (Min. 150 hours): Theory Practice ELECTIVES: Theory Practice
Massage Therapy (Min. 150 hours) Related Hands-on Modalities (List):
Contraindications of Massage Therapy
Other (List):
Clinical Practicum (Max. 150 hours) N/A
Sub Total: Counseling
Theory & Practice Total: Herbology
Homeopathy
Nutrition
CURRICULUM TOTAL (Min. 650 hrs.): Breathing & Stretching Techniques
Theory
Other (List):
Sub Total:
Theory & Practice Total:
New Mexico Regulation and Licensing Department
BOARDS AND COMMISSION DIVISION
Page 2 of 6 Revision date: 09/2008
Massage Therapy Board
MASSAGE THERAPY SCHOOL 2008 RENEWAL APPLICATION
SECTION C – SYLLABI
The syllabus must be provided for the entire curriculum.
The calendar for each program need NOT be submitted. However, the calendar for each program must be in place no later than the first day of
class. Furthermore, the Board and/or its designee may conduct an audit of the calendar with or without prior notification or arrangements.
The information outlined in this Section is to be provided for ALL curriculum outlined in Section B. However, if the course is offered in more
than one program, the syllabi for the course only needs to be provided ONE time.
EACH course must be broken down with a separate page(s) for each course, and grouped in the order outlined in Section B. (e.g. All elective
courses for all programs must be grouped under “Electives”, with the tabs/dividers separating the category, i.e. A&P, MT, General, and
Electives.
All boxes must be checked, and all boxes checked must have the supporting documentation/information requested attached/enclosed.
The following minimum information must be provided for each course:
Name of course (exactly as outlined in Section C of this application)
Detailed description
Objectives
Required school prerequisites
Where applicable, required Massage Therapy Board prerequisites
Total number of class or contact hours required (exactly as outlined in Section C of this application) to
include the definition outlined in 16.7.1.7.B NMAC
Name of instructor(s), where applicable include the registration number of the Massage Therapy Instructor.
Instructors who are registered as Massage Therapy Instructors must be listed with the name as inscribed
on their registration
Instructional materials to be used
Provisions for make-up work, if any
Requirement for successful completion
Revision date.
SECTION D – REQUIRED DOCUMENTATION
Although the Board is not requiring you to submit the supporting documentation listed in this section, the Board and/or its designee may conduct an audit of the
documentation with or without prior notification or arrangements.
The following minimum requirements MUST be met and in place at the time of renewal. ALL boxes MUST be checked attesting that the requirements have
been met and documentation is in place.
ADMISSION APPLICATION
Full name of the applicant, to include address phone number and date of birth;
If applicable, Application Fee, and terms relating to cancellation and refund; and
A certification statement certified and dated by the applicant, certifying that the applicant has received a complete copy of the
Admission Application and any attachments referenced to in the admission application and admission supplements.
ENROLLMENT AGREEMENT/CONTRACT: the enrollment agreement/contract is in place and it includes at a minimum the information
listed below:
School name, address and phone number
Total tuition cost for the program
Tuition cost for partial training per hour
Enrollment Fee including tax
Minimum tuition deposit required
Cost for books, supplies and other expenses
Administrative costs for withdrawal or termination
Payment methods and terms including interest
Refund policy
Right to cancel enrollment agreement (school and student)
Right of withdrawal or termination of enrollment (school and student)
Withdrawal or termination prior to start of program
Withdrawal, abandonment or termination after program starts
Program start date
Credits, hours and financial, for prior training
Total hours of program, including prior training credit
Attendance requirements
Attendance requirements
New Mexico Regulation and Licensing Department
BOARDS AND COMMISSION DIVISION
Page 3 of 6 Revision date: 09/2008
Massage Therapy Board
MASSAGE THERAPY SCHOOL 2008 RENEWAL APPLICATION
Employment disclaimer;
Graduation requirements;
A certification statement certified and dated by the applicant, certifying that the applicant has received: (1) a complete copy of the
Enrollment Agreement/Contract and any attachments referenced to in the enrollment agreement/contract and enrollment
agreement/contract supplements; (2) the calendar for the enrolled program or the date when the calendar for the enrolled program
will be provided, which shall be provided no later than the first day of class; and (3) the advertising catalog, and catalog supplements
outlined in Attachment 5 of this application.
ADVERTISING CATALOG: The advertising catalog is in place and it includes at a minimum the information listed below:
Date catalog and catalog supplement was printed/revised
School name, address (mailing and physical), telephone number, e-mail address and website
Table of contents and page numbers
Mission, objectives, and goals of the school
List of facility with their titles, which may include instructors and where applicable their Massage Therapy Instructor registration
number
Admission requirements, procedures and prerequisites
Grading system
Length of time required for completion of the program
Completion, graduation requirements
Attendance Policy
Leave of Absence Policy
Dress Code Policy
Sanitation/Hygiene Protocol Policy (personal hygiene, washing of hands after a massage treatment, cleaning lotion bottle,
cleaning table, linen care, equipment care, etc.)
Universal Precautions Policy
Draping Policy and Procedures
Student Complaint Policy – to include the Massage Therapy Board name, address (mailing and physical), telephone number, e-
mail address and website, as an avenue to file a complaint, only after the student has exhausted the procedures available at the
school, or if extreme circumstances exist whereby the student cannot utilize the school’s procedures.
Student Conduct and Ethical Requirements – to include outlining 16.7.2 NMAC in the ethical requirements, and including outlining
the basis for termination and the termination procedures.
Transfer Credit Policy – which provides the process and verification procedures to be followed when accepting training received by
the student from another school, and how the transfer courses will be reflected on the transcript. Such training transferred
CANNOT include continuing education, life experience or experience gained through employment related to the program of study.
Courses transferred shall parallel in content and intensity to the courses presently offered by the massage therapy school.
Partial Training Policy – which provides the process used for students who completed their training in another school and lack the
minimum educational requirements for licensure. The course(s) and hours for partial training shall correspond to the course(s)
and hours outlined in Section C of this application.
Readmission Policy – which provides the process and timelines in which a student who has withdrawn from the school’s program
can reapply and obtain credit for the training completed at the school, before the student must complete the entire program and no
credit for past training completed will be credited.
Clinical Practicum Policies and Procedures – to include at a minimum the following:
Massage Therapy Board exemption provision outlined in the Massage Therapy Practice Act, 61-12C-5.1.B
Massage Therapy Board “Clinical Practicum” definition (16.7.1.7.C NMAC)
Massage Therapy Board “Professional Conduct” rule (16.7.2 NMAC)
Massage Therapy Board “prerequisite” requirement outlined in 16.7.5.8.B (2)(b) NMAC
Massage Therapy Board “Students” rule (16.7.7 NMAC)
Disclosures, to include at a minimum the following:
Massage Therapy Board age requirement in order to obtain a massage therapy license (16.7.4.8.A (1) NMAC)
Massage Therapy Board high school or its equivalent requirement in order to obtain a massage therapy license (16.7.4.8.A
(2) NMAC)
Massage Therapy Practice Act requirement that persons must be licensed as Massage Therapists in order to advertise and
offer massage therapy services
Licensure Requirements – a brief description of the Massage Therapy Board requirements, to include at a minimum the following:
Licensure minimum educational requirements
Examination requirements including the National Certification Examination for Therapeutic Massage and Bodywork and the State
Jurisprudence Examination
New Mexico Regulation and Licensing Department
BOARDS AND COMMISSION DIVISION
Page 4 of 6 Revision date: 09/2008
Massage Therapy Board
MASSAGE THERAPY SCHOOL 2008 RENEWAL APPLICATION
Advertising requirements including the requirement that licensure for the practice of massage therapy is required in the Massage
Therapy Practice Act in order to offer and/or advertise massage therapy services
Massage Therapy Board address (mailing and physical), telephone number, e-mail address and website for obtaining information
and the application packet needed to apply for licensure
Student Complaint Policy & Procedures, to include the Massage Therapy Board name, address (mailing and physical), telephone number,
e-mail address and website, as an avenue to file a complaint, only after the student has exhausted the procedures available at the school,
or if extreme circumstances exist whereby the student cannot utilize the school’s procedures; which is required to be posted in a
conspicuous place on the premises
TEACH-OUT POLICY: The teach-out policy is in place and it includes at a minimum the information listed below:
The name of at least one (1) registered Massage Therapy School (“receiving school”) with which a teach-out agreement has been entered
into, the agreements shall include that the receiving school shall receive at a minimum the following:
A current and past listing of all students, including their date of birth.
Current and past student records, which must include an original transcript of the courses, hours, dates, and instructors names for
the courses taught by each instructor and completed by the student.
Proof of paid and unpaid tuition, refunds due, and account balances.
The method and timelines to be used to ensure the receiving school receives any amounts due, or the students are refunded any
amounts due.
If there is no teach-out plan with a registered massage therapy school, then the teach-out plan must include providing the massage
therapy board with the following:
A listing of all students (current and past) with their date of birth.
Student records (current and past), which must include an original transcript of the courses, hours, dates, and instructors names for
the courses taught by each instructor and completed by the student.
Proof of paid and unpaid tuition, refunds due and account balances.
The method and timelines to be used to ensure the students are refunded any amounts due.
The teach-out plan must also include the procedures and timelines the school will follow prior to the school closing in providing notification
to the students, the receiving school, and the massage therapy board of the impending closure and the timelines for issuance of refunds,
and transferring all student records (current and past) to the receiving school or the massage therapy board
FORMS: At a minimum, the following forms are in place:
Instructor evaluation of the student on massage therapy techniques.
Student evaluation of the instructor on the teaching provided.
Client intake and screening, which is used to obtain relevant information from the client.
Disclosure statement, which includes prior informed consent regarding draping and treatment, privacy of the client while dressing and
undressing, modification or termination of treatment at the client’s request, maintenance of equipment, linens, clothing and work area, etc.
Client feedback, which is used to evaluate the student on the services rendered.
TRANSCRIPT: To include at a minimum, the following:
Full name of school, as registered with the Massage Therapy Board, to include mailing address, phone number, fax number,
e-mail address and website.
Signature of school director, to include date of signature.
The heading entitled “Official Transcript” or equivalent.
School seal affixed to the transcript.
Full legal name of the student with the student’s date of birth.
Date of entrance into the program.
Date of completion of the program.
The total hours that the student successfully received for the program.
The course name, number of hours successfully completed and the respective category credited (A&P, MT, General Instruction, or
Elective) exactly as outlined in the curriculum in Section C.
If applicable, for each course transferred from another school: (1) the course(s) name; (2) number of hours transferred for each course;
and (3) the name of the transferring school(s); which shall have a copy of the transcript from the transferring school attached to the
transcript.
New Mexico Regulation and Licensing Department
BOARDS AND COMMISSION DIVISION
Page 5 of 6 Revision date: 09/2008
Massage Therapy Board
MASSAGE THERAPY SCHOOL 2008 RENEWAL APPLICATION
FACILITY AND INTSTRUCTORS: To include at a minimum, the following:
Name, and where applicable, Massage Therapy Instructor registration number
Course(s) that will be taught
Documentation of the training and experience in the area of the course(s) that will be taught
Resume
Facility and Instructors Conduct and Ethical Requirements, including outlining the basis for termination and the termination procedures
CLIENT CLINICAL PRACTICUM COMPLAINT POLICY AND PROCEDURES: To include the following information which must be posted in a
conspicuous place on the school premises for the client to file a complaint of alleged violations of the Massage Therapy Practice Act or its
regulations.
The Massage Therapy Board’s name.
The Massage Therapy Board’s address (mailing and physical)
The Massage Therapy Board’s telephone and fax numbers.
The Massage Therapy Board’s E-mail and Website addresses.
The Massage Therapy Board’s telephone and fax numbers.
FLOOR PLAN: To include all dimensions. The use of each room or space must be clearly labeled.
SECTION E – THE FOLLOWING QUESTIONS MUST BE ANSWERED
1. Within the last two (2) years, has the director, any board member or any person holding an ownership Yes No
or controlling interest in this school been convicted of any offense punishable by incarceration in a state
penitentiary or federal prison?
2. Within the last two (2) years, has the director, any board member or any person holding an ownership or Yes No
controlling interest in this school been involved in any civil litigation involving the operation, management,
or practice of massage therapy?
3. Is the director, any board member or any person holding an ownership or controlling interest in this Yes No N/A
school currently more than thirty (30) days in arrears in payment of amounts required to be paid pursuant
to a court-ordered judgment and order.
For any “YES” answer(s), you must provide details, including the outcome, on a separate sheet and attach supporting documentation including, but
not limited to the following:
Certified copies of the legal documents, certified by the Clerk of the court entering the conviction.
Character reference letters from family, friends, colleagues, employer, etc., to include their addresses and phone numbers.
If you are still on probation, an original letter addressed, signed, and submitted to the Board by your Probation Officer, which outlines
the status of your probation and which is dated within one (1) month of the date of this application.
For Question #3, a certified Statement of Compliance from Human Services Department (HSD) Child Support Enforcement Division
(CSED), with a copy of the Judgment and Order for support; and any other relevant documentation regarding the matter.
SECTION F– APPLICANT’S ATTESTATION
I hereby certify that ALL instructors teaching “Massage Therapy” as defined in Sections 61-12C-3.E of the practice Act, and Section 16.7.1.7E
NMAC of the Board’s Regulations, are licensed as massage therapists and registered as massage therapy instructors by the Board. Under
penalties of perjury, I/we declare and affirm that the statements made in the foregoing application, including any attached documentation, are
true, complete, and correct. /we understand that any false or misleading information in, or in connection with, this application may be cause for
denial or loss of this school’s registration.
SOLE PROPRIETORSHIP OR OTHER:SIGNATURE: _____________________________________ DATE: ___/___/____
PARTNERSHIP:
SIGNATURE – PARTNER #1 ________________________________________________ DATE: ___/___/____
SIGNATURE - PARTNER #2 ________________________________________________ DATE: ___/___/____
SIGNATURE - PARTNER #3 ________________________________________________ DATE: ___/___/____
If there are more than three partners, make a copy of this page, complete this section on that sheet and attach it to the application)
PROPRIETARY CORPORATION OR LIMITED LIABILITY COMPANY: DATE: ___/___/____
CORPORATE OFFICER OR CORPORATE DIRECTOR OR OWNER: ___________________________________________________
PUBLIC INSTITUTION OR NON-PROFIT CORPORATION: DATE: ___/___/____
AUTHORIZED GOVERNING BOARD MEMBER: _____________________________________________________________________
SCHOOL DIRECTOR: _____________________________________________________________________________ DATE: _____/____/______
New Mexico Regulation and Licensing Department
BOARDS AND COMMISSION DIVISION
Page 6 of 6 Revision date: 09/2008
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