SAS Application - CMTDEV.ca

College Name *

MOT Educational Program Title *

Primary Contact

The Primary Contact is the person that will be communicating directly with CMMOTA during the SAS process.

First Name *

Last Name *

Title *

Email *

Phone *

Have the Primary Contact and Secondary Contact read, reviewed and understand the School Steps to Approval document? *

Yes

Secondary Contact

Secondary Contact is the person that will be contacted if the primary contact is unavailable

First Name

Last Name

Title

Email

Phone

Mailing Address

Address Line 1 *

Address Line 2

City *

Province *

Contributors

Add below the details of all the additional individuals who will be contributing content to the SAS application. (They will each have a unique login in order to upload documents to the SAS application)

First Name

Last Name

Email

First Name

Last Name

Email

First Name

Last Name

Email

First Name

Last Name

Email

First Name

Last Name

Email

First Name

Last Name

Email

Payment Options

Please select a preferred payment option. Instructions on how to complete the payment will be sent via email. *

Interact E-Transfer

Paypal Credit Card

CMMOTA Confidentiality Declaration

I, the undersigned, acknowledge that I may be entrusted with privileged and confidential information, which, upon disclosure, would be highly prejudicial to the best interests of the Canadian Massage & Manual Osteopathic Therapists Association (CMMOTA). I also acknowledge and agree that the right to maintain confidential all such information constitutes a proprietary right with the Canadian Massage & Manual Osteopathic Therapists Association, which the Canadian Massage & Manual Osteopathic Therapists Association is entitled to protect. Accordingly, I agree to keep such information in strict confidence and not to use same for my benefit, directly or indirectly, or to disclose to any company, firm partnership, third parties or persons not authorized by the Canadian Massage & Manual Osteopathic Therapists Association which may come to or is in my knowledge.

This is a Declaration between the MOT Educational Program listed within this application and the Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA). The Declaration is effective on 12/05/2024.

Terms: This Declaration is effective on the Effective Date and shall remain in effect thereafter.

Covenant Not to Compete: The CMMOTA will not engage in any business activity which competes with the MOT Educational Program.
Non-solicitation: The CMMOTA agree not to solicit any employee or independent contractor of the MOT Educational Program on behalf of any other business enterprise.
Safety, Security and Privacy:

By checking the box below, I understand and agree to the confidentiality declaration as stated above. *

Yes

Personal Information Protection Act (PIPA)

In order to provide and improve member services, CMMOTA collects personal and business-related information from the School Approval System Application. By signing this form, you are providing your consent for CMMOTA to use and publish your personal information, with the exception of your date of birth and personal contact information (if it differs from your business contact information). The consent provided by you to use your personal and business information will continue throughout the duration of your school being approved with CMMOTA unless revoked in writing, in which case such notice must be delivered to the CMMOTA Head Office. The information collected by CMMOTA will be used for the purposes of promotion of the membership and membership services, statistical and membership analysis, communicating with third parties in association with the business operations of CMMOTA, regulation and enforcement of the Bylaws and Policies of CMMOTA (as may be amended from time to time), and any other purpose that supports the Objects and business of CMMOTA and its Membership.

The checkbox below is to be considered as consent to the collection, use and disclosure of personal information as described. The checkbox below is also considered as consent for the Canadian Massage and Manual Osteopathic Therapists Association to publish business contact information and treatment types available in various formats as required from time to time, including areas of the CMMOTA website.
I enter into this agreement totally voluntarily, with full knowledge of its meaning, and without duress.

By checking the box below, I understand and agree to the PIPA agreement as stated above. *

Yes

Authorization

“I am authorized to apply for the CMMOTA SAS on behalf of the manual osteopathic program. I authorize the CMMOTA staff and Reviewers to contact myself, and the Secondary Contact, regarding the SAS process. I authorize the CMMOTA staff and Reviewers to review evidence and materials submitted to the CMMOTA for the purposes of the SAS process. Evidence and materials submitted to the CMMOTA, are to the best of my knowledge authentic and complete. I understand that the CMMOTA charges fees for the following:

$150.00 Application fee, which is paid upon submitting the Application to the CMMOTA
$2000.00 for the Review, feedback and approval process and this will be paid in full to the CMMOTA office at the time the Benchmarks and Deliverables are submitted.

* Fill in your full name and the school name in the fields below to indicate you agree to these terms as outlined. *

Enter Your Full Name *

Enter The School Name *

Approximately when does the MOT educational program plan to submit the Benchmarks and Deliverables for CMMOTA SAS Review? *

Application Submission Date