Your Email Address *

TO complete CLICK 'SUBMIT' AND YOU WILL BE RE-DIRECTED TO PAYPAL FOR PAYMENT. if you wish to make payment through paypal complete the transaction there. If not, close paypal out and call us at 319-462-3402 to make payment over the phone.

Comments

Address: *

City/State: *

Electronic Signature authorizing release of your information (must also call with confirmation)::

Zip Code: *

Date: *

For the duration of (indicate length of program, if current student)::

Name of Institution or business that transcripts or materials are to be sent: *

Contact Person/Authorized person to receive your educational or financial materials as indicated above:

Your Name: *

Your Phone Number *

Carlson College of Massage Therapy FERPA Release