Application for The 2020-2022 Aston® Movement Certification Training Program

Before applying, please review the requirements carefully. The fees for the application are nonrefundable.

Requirements to apply:

You must be a movement therapist or trainer and/or set to graduate from your program before the end of 2021.
Have a license to practice that fulfills your state or local requirements.
Completed Aston® Kinetics 101 & 102 classes
One Private Session with a Certified Aston-Patterning® Practitioner
Current Liability Insurance (options available)

Before acceptance to the program the applicant will be contacted to schedule an entrance interview. Once the interview has been completed the applicant accepted, the applicant will be contacted with an acceptance letter, welcome package, payment plan options and contract.

Name *

First Name Last Name
E-mail *
Date of Birth *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Occupation
Statement of Purpose *
What has led you to pursue the Aston® Movement Certification Training?
Education/Degrees *
Please list your professional education/degrees, such as a higher education degree, academic training in education, health care or a related field, working knowledge of anatomy/kinesiology or a diploma from an accredited school of massage.
Scanned copy of massage school, physical therapy school or movement practice diploma/certificate *
Scanned copy of massage license or medical license or other license *
Scanned copy of liability insurance
If you do not have current liability insurance, contact our office for options. Liability insurance is required before training begins.
Recent Photo *
Which foundation courses have you completed (Aston Kinetics 101 & 102) *

Aston® Postural Assessment: AK 101 Aston® Kinetics, Moving Beyond Posture: AK 102
If you have not completed these courses, what courses do you still need to take? When do you plan on completing these courses?
Have you received a private Aston-Patterning® session with a currently certified Aston-Patterning® practitioner? We recommend that you receive at least 1 full session of bodywork and movement prior to the training. *

Yes No
If not, when do you plan on scheduling a session?
Please note how you plan on paying for training: *

Pay in full. I have questions about payment plans.
Do you have any comments about payment plans?
Questions on training payment:
Additional Questions:

My Products

Aston Movement Cert Application Fee $ 150.00

Total $ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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Application for The 2020-2022 Aston® Movement Certification Training Program

Aston Kinetics

P.O. Box 3568 Incline Village, NV 89450 | 775.831.8228 | office@astonkinetics.com

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