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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