Application form

application date

	Name

	First name

	Address

	City

	State, Province or Country

	Postal code

	Phone number

	Cell phone number

	Fax number

	Email
	@

	Date of birth

Please include the following documents
with your online application

	Curriculum Vitae (.doc format)

	Letter of motivation (.doc format)

	Letter of goals (.doc format)

	Reference letters (.doc format)-Optional

	Picture (.jpeg format 1mb max.)

	Copies of any relevant diplomas or attestations (.pdf or .jpeg format)

	Do you want to make your payment now? (optional)
	YES NO

Application FEES 100 $ CDN
(for all applications)

	*Application fees are not refundable.
	Payments can be made online by credit card or Paypal. If you are paying by cheque, please make your cheque payable to Kiné Concept Montreal and send by mail to 760 rue St-Zotique Est, Montréal, Québec, H2S 1M5. Payments in cash or debit card can be made in person at the reception of the Academy at this address. Make sure to ask for your receipt.

	Credit card number

	Type of credit card

	Expiration date

Security Number What is this?

	Electronic signature
	I accept these terms