Name:___________________________________________________________
APPLICATION CHECKLIST
Check off (√) the items included in the application packet.
_____ Completed application form for certification/registration.
_____ Attached photos (TWO recent 2" x 2" - head & shoulders). One photo on Page 5 with Notary Seal
placed over edge of photo. The second photo can be attached to any page of the application.
_____ Copy of certificate or Official Candidate Score Report to verify passing the National Certification
Board for Therapeutic Massage and Bodywork (NCBTMB) examination. Board accepts NCETMB
and NCETM examination results.
For information: Call or visit the web site www.ncbtmb.com
OR
_____ Copy of National Certification Commission for Acupuncture & Oriental Medicine (NCCAOM)
certificate or the Official Exam Score Report to verify passing the NCCAOM examination.
For information: Call or visit their web site www.nccaom.org
_____ Application fee of $100.00 by certified check or money order made payable to:
"Maryland of Board of Chiropractic Examiners"
_____ Jurisprudence examination registration form AND $ 50.00 fee by certified check or money order
payable to the Maryland Board of Chiropractic Examiners. To study for this examination, review the Maryland Massage Therapy laws and regulations.
Contact: Denise Harris for additional information.
_____ Copy of massage therapy school and/or college transcript(s).
_____ Have you requested that your official college/massage school transcript(s) be sent directly to
the Board?
DHMH - Board of Chiropractic Examiners
Massage Therapy Program
4201 Patterson Avenue
Baltimore, MD 21
* * * * *
If you attended a foreign school (outside of U.S.A.), are you willing to pay the fees to the contract commission, ICHP, to investigate, review and verify your school and transcripts (fees could range from $300 - $500)? If yes, you must contact the company on the attached sheet and follow their directions.
Your application will not be processed unless/until the board receives a report from the company.
Also, you are advised that if an investigative review is conducted, this does not guarantee that your
transcripts and application will be approved.
* * * * *
An application receipt letter will be mailed within 10 business days
after the application is received by the Board.
06/05DH
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