Steps’ Steele Pilates Teacher Certification Program Application Checklist
(International Students)
Items to be included in your Application Packet*:
□ Completed application checklist
□ Completed application form
□ Letter of introduction detailing the type of Pilates you have been studying (if any), the number of years you have been
studying, and any current certifications you may have. Please also describe any dance training you have had and the
number of years you have been studying. Please describe your future goals in the dance/fitness industry.
□ Dance and Fitness resume (if any)
□ One passport sized photograph
□ One photo in a dance or fitness pose that highlights your technique
□ Health Form
□ Copy of Current Passport
□ Financial documentation proving funding for tuition and living expenses. Please refer to International Student Guide
for acceptable forms of documentation
□ Non-refundable $200 application fee payable by bank transfer, credit card, money order, or travelers checks in U.S.
dollars. Cash is not accepted.
 For bank transfer - JP Morgan Chase 2099 Broadway New York, NY 10023; Account # 771178944
Routing # 021000021. Please include an additional $28 for bank fees.
 Credit cards - American Express, MasterCard or Visa only.
* - Incomplete application packets will not be accepted
________________________________________________________________________________________________
Acceptance
Within two weeks of receiving your completed application, Steps on Broadway will notify you by email of your
acceptance.
____________________________________________________________________________
Items to be sent After Acceptance:
Fifty percent (50%) of the tuition is due within ten (10) days of receiving your acceptance notice. The remaining fifty
percent (50%) is due ten (10) days prior to your program start date. Non-payment will result in delay or loss of position
within the program. Payments plans are based upon financial need on an individual basis.
All rates are subject to change.
__________________________________________________________________________________________________________
Mailing address:
Steps on Broadway
Professional Training Programs
2121 Broadway @ 74th Street, Third Floor
New York, NY 10023
Steps’ Steele Pilates Teacher Certification Program Application Form
(International Students)
First Name______________________________________Last Name_________________________________________
Email__________________________________________Phone____________________________________________
Address in Home Country __________________________________________________________________________
Street
______________________________________________________________________________________________________________________
City
State
Postal Code
Country
Address in New York (if established)___________________________________________________________________
Street
______________________________________________________________________________________________________________________
City
State
Zip
□ Male □ Female
Date of Birth______/____/_____
Month
Day
Native Language________________________
Year
Country of Birth_________________________________ Country of Citizenship_______________________________
Current Certifications (if none, write none)______________________________________________________________
Passport Number_________________________________ Expiration Date____________________________________
I WOULD LIKE TO ENROLL IN (students may select both sessions):
□
□
Mat Certification (October 1, 2014—December 31, 2014)
Application deadline August 1, 2014
Advance Certification (January 1, 2015—March 31, ,2015) Application deadline November 1, 2014
Enclose a check for the Application Fee of $200.00 made payable to Steps on Broadway
Credit Card:
□
American Express
□
MasterCard
□
Visa
Name on Credit Card__________________________________________________________________________
Number_____________________________________________________Expiration Date___________________
How did you hear about this program?___________________________________________________________________________
I hereby represent that I am over eighteen (18) years of age
X________________________________________ Print Name_______________________________
Date________________
PROFESIONAL TRAINING PROGRAM HEALTH FORM
I. STUDENT INFORMATION
Name _______________________________________________________________________________
(Please Print)
Phone Number ____________________________________ Date of Birth ________________________
(Month/Day/Year)
Emergency Contact ____________________________________________________________________
Relationship to Student __________________________ Phone Number __________________________
_____________________________________________________________________________________
II. HEALTH INSURANCE INFORMATION
(Please note that health insurance is required for all PTP students)
Do you currently have health insurance coverage?
Yes
If yes: Insurance Company _____________________________ Dates of Coverage _________________
(Please include a copy of your health insurance card or other proof of insurance with this application)
No, please send me information about Steps’ Group Health Plan (International Students Only)
No, I plan to find coverage prior to enrollment and will provide proof of insurance at orientation.
_____________________________________________________________________________________
III. MEDICAL HISTORY
Do you have any medical conditions that we should be made aware of?
Yes
No
If yes, please list the medical condition(s):
_________________________________________________________________________________
_________________________________________________________________________________
Is there any other information regarding your condition(s) that you would like us to know?
____________________________________________________________________________________________
____________________________________________________________________________________________
___________________________________________________________________________________________
III. MEDICAL HISTORY (continued)
Do you take any medications?
Yes
No
If yes, please list all medications:
________________________________________
_________________________________________
________________________________________
_________________________________________
Do you have any allergies?
Yes
No
If yes, please list all allergies:
________________________________________
_________________________________________
________________________________________
_________________________________________
Permission to Dispense Non-Aspirin Medication: By company policy, Steps Studio Inc. staff will not administer
any medication without your prior authorization. If you authorize staff to dispense a non-aspirin pain reliever
product (i.e., Tylenol) please read below.
For cases of headache and/or minor aches or pains, Steps Studio Inc. has my permission to administer a nonaspirin pain reliever product.
If you do not authorize Steps Studio Inc. to dispense medication do not sign below and initial here
_____________________________________________________
_____________________________
(Student Signature)
(Date)
Please list any physical and/or dance related problems you have including injuries, bone, joint or muscular
disorders, etc.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
ACKNOWLEDGEMENT
I do hereby state that, to the best of my knowledge and belief, the medical history I have provided is correct
and accurate. I agree to report, in a timely manner, injuries and/or conditions that are pre-existing or have
occurred while participating in the Professional Training Program (PTP). I understand my medical history is
confidential under state and/or federal laws and that Steps Studio Inc. staff will not release to anyone or
discuss with anyone outside of the company, unless separately authorized by me or required or permitted by
law.
I authorize Steps Studio Inc. to speak in their sole discretion with any Hospital Representative and/or Medical
Provider about injuries, illnesses, treatment and rehabilitation that may affect my ability to participate in the
PTP and/or any injury suffered during my participation in an activity associated with PTP.
My signature below acknowledges that I understand and agree to the terms above.
_____________________________________________________
(Student Signature)
_____________________________
(Date)
International Student Application Guide
Financial Support*
To be accepted to Steps on Broadway, international students must have sufficient funding for both school tuition and living
expenses for the duration of their program.
All documents must be in English and currency in US dollars. Students must prove an amount greater than or equal to:
Independent Study Program
 $7,500 for a 3 month period
 $13,000 for a 6 month period
 $26,000 for a 12 month period
2-Year Conservatory Program
 $26,500 for a 9 month period
 $32,500 for a 12 month period (students planning to stay in New York during summer break)
Steps’ Steele Pilates Teacher Certification Program
 $8,700 for a 3 month period
 $17,400 for a 6 month period
The following documents are acceptable forms of financial support:





Official Bank Statement-The statement must be on bank letterhead and in the name of the applicant or sponsor.
Official Bank Letter-The letter must be on bank letterhead and confirm a balance equal to or in excess of the tuition and living expenses for the expected length of studies.
Official Proof of Income or Employment of Family Member-A letter, paycheck stub, or annual income tax
return from a family member proving employment and ability to provide for your tuition and living expenses. Family member must prove an amount greater or equal to double the monthly tuition/living expenses of the student.
Affidavit of Support– If the statement, letter or proof of income is in the name of any individual other than the
applicant, the sponsor must provide a letter stating that they are willing to support the applicant for the duration of
their course of study.
Official Award Letter-If the applicant is receiving a government or institutional scholarship, grant, or loan, please
submit the award letter. The award letter must state the amount and duration of the scholarship, grant or loan and
must specify if the funds are renewable on an annual basis. If the award does not cover the total cost of tuition,
fees and living expenses, additional financial documentation must be enclosed.
Health Insurance
Students are expected to carry health insurance for the duration of their course of study. Students may provide proof of
current health insurance or sign up for the group plan through Steps on Broadway. More information available upon request.
*Please note these are not tuition prices. They are tuition and living expenses combined.