Name

Date of Birth

Occupation

Street

City

State/Prov

Zip

Daytime Phone

Evening Phone

Cell Phone

Preferred Phone

Choose One Daytime Phone Evening Phone Cell Phone  

E-Mail

Do you check your e-mail daily?
 Yes     No

Emergency Contact Name and Number
 

Will you need overnight accommodations during the training weekends?
 Yes     No

If yes, what type of accommodation would you prefer:
 a local motel/hotel (15 minute drive to the studio)
 stay with a local student also participating in the program (you will be responsible for these expenses but we will help with arrangements)

Do you have any physical health concerns? (be specific)
 

Do you have any emotional or psychological health issues? (be specific)
 

Are you taking medications for the above concerns or other conditions?
If yes, please list.
 

Please try to be precise and concise as you answer the following questions:

1. What is your background or interest in mind-body health and healing?
 

2. Yoga practice can take many shapes and forms. How do you define Yoga practice? What would you say is the value of practice? Do you have a current practice? What does it look like? If not, are you interested in integrating practice into your life? And what do you imagine it will look like?
 

3. For the internship piece of this program you will be teaching an 8 week class. What population would you like to serve?
 

4. This program will require time for practice, teaching, self-reflection, reading and study of material. What is your plan for finding balance in your work, recreation and family life while in the program?
 

5. What is your personal intention for taking the training program and how do you imagine that it will impact your life personally, professionally, socially and emotionally?
 

6. If a student traveling a long distance for the program needs a place to stay on Friday or Saturday night, would you be interested in accommodating them? If yes, Would you like to be compensated for this service? If yes, how much?
 

Please click on the button below to submit your Teacher Training application, then follow the instructions to send your application fee.