Massage Therapy Program Application

We are pleased to learn of your interest in the Lake Land College Massage Therapy Program. All classes in this Program are held at the Lake Land College campus in Effingham (Kluthe Center). The Massage Therapy classes begin each spring or fall semester and run for 4 consecutive semesters.

To be considered a candidate, you must have the Lake Land College intent to enroll completed, the Program application completed (below), and the Lake Land College Assessment tests completed by July 1 for consideration for the Program beginning in the fall term. The Program application can be submitted from the Program’s website. Contact the Testing Center at 217-234-5301 to schedule the assessment tests.

Please call me at 217-540-3551 if you have further questions.

This form is not an application to the College. It is part of your application to the program.

Massage Therapy Program Application

Personal Information


Colleges (if applicable):
College Name:
Degree Earned:

College Name:
Degree Earned:

College Name:
Degree Earned:

College Name:
Degree Earned:

Declaration of Intent


  • This application does not mean admission to the program.
  • There is no waiting list from year to year. You must contact the Program Secretary at the Kluthe Center to advance your file to the next year.
  • It is your responsibility to see that your file is complete before the July 1 deadline.
  • You will be asked to work on one another and expected to play the role of a patient during labs.  Hands on demonstrations are required by instructor/student and student/student.
  • COVID-19 information:
    • Lake Land College has implemented requirements and procedures in accordance with the Governor's Executive Order mandating vaccination or weekly COVID-19 testing for all Illinois higher education personnel and students, the related Illinois Community College Board directives, and guidance from the CDC and IDPH. All students and employees are responsible for reviewing and following the requirements and procedures as presented on the College's Pandemic Response Safety Guidelines posted on the College website.
    • Currently, masks covering the nose and mouth are required indoors at all times for both vaccinated and unvaccinated individuals, except when the individual is alone in an enclosed office with the door closed. Individuals refusing to wear a mask appropriately indoors will be required to leave. Students and employees who have not submitted documentation confirming full vaccination are required to complete a COVID-19 test on campus weekly or submit weekly results of a third-party test (see website for information regarding submission of third-party test results). Individuals who have medical conditions or religious beliefs that preclude vaccination must test weekly. There is no exemption from weekly testing unless individuals are fully vaccinated. Compliance will be monitored and individuals who are not in compliance will be excluded from campus. Repeated non-compliance may result in withdrawal from in-person classes and disciplinary action.
    • The Allied Health Programs guidelines and expectations align with the requirements and procedures presented in the College's Pandemic Response Safety Guidelines. If the College updates the requirements and procedures, the Allied Health Programs will follow the new guidelines. If clinical partners impose requirements that are more restrictive, such as a vaccination mandate, the Allied Health Programs will follow the clinical partner's requirements. If a student refuses to comply with the clinical site's requirements, he/she will fail to meet clinical objectives and will therefore fail the course.

  • Student must maintain “C” or above in ALL course work once admitted to the Massage Therapy program and maintain a 2.0 GPA in the Program.
  • Student must progress through courses corresponding to the curriculum model once admitted to the Massage Therapy program.
  • Student must sign the statement of understanding and compliance with confidentiality of client information.
  • Student must maintain professional standards of health.
  • Student attendance in all classes, labs and clinics is mandatory.


All students in the Lake Land College Massage Therapy program must be able to perform diverse, complex, and specific functions and skills. These qualifications are essential for successful completion of the requirements of the program and are necessary to ensure the health and safety of patients, peers, faculty and other healthcare providers. The essential qualifications include but are not limited to the following abilities:

  1. The ability to perform full range of motion of joints and fine motor movements of the hands.
  2. The ability to elicit information from clients by palpation, observation, auscultation, and other assessment methods.
  3. The ability to execute movements required to provide a massage to a client in all health care settings including emergency treatment: e.g. transferring, lifting and turning patients, assisting client in activities of daily living and providing cardiopulmonary resuscitation.
  4. The ability to push or pull an occupied wheelchair.

  1. The ability to observe a client accurately at a distance and close at hand. This requires functional use of the senses of vision and hearing.
  2. The ability to perceive the signs of disease and infection as manifested through physical examination, including from images of the body surfaces, palpable changes and auditory information.
  3. The ability to observe non-verbal communications when performing an assessment and massage.
  4. The ability to use spoken and written English to communicate in a coherent manner and the ability to convey or exchange information with individuals of all professions and societal levels.
  5. The ability to process and communicate information on the client's status with accuracy in a timely manner to members of the health care team.
  6. The ability to navigate through different computer software.

  1. The ability to utilize intellectual abilities, exercise good judgment, and promptly complete all responsibilities relevant to the massage and care of a client.
  2. The ability to maintain mature, sensitive, and effective relationships with clients, faculty, staff and other professionals under all circumstances.
  3. The ability to recognize that one's own values, attitudes, beliefs, emotions, and experiences affect one's perceptions and relationships with others.
  4. The ability to function effectively under stress and to adapt to an environment that may change rapidly without warning and/or in unpredictable ways.
  5. The ability to learn and abide by professional standards of practice.
  6. The ability to engage in client care delivery in all settings and be able to deliver care to all client populations.
  7. The ability to respond in an emotionally controlled manner in learning situations and emergencies.
Students not adhering to these responsibilities and standards will be removed from the program. Program dismissal may be appealed by initiating the request through the Program Coordinator.

I have read and understand the above statements and accept the responsibilities and standards listed.