Teacher Training Application

Name * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Alt Phone - (###) - ### ####
Email *
Emergency Contact First Last
Emergency Contact Phone - (###) - ### ####
Occupation
Employer
Which program are you applying for? 21 Day Intensive Summer 2010 Weekend Format October 2010 21 Day Intensive June 2011 21 Day Intensive July 2011 Weekend Format October 2011
How did you hear about this program?
Family Statistics: (children, spouse, significant other, etc…)
What is your gender, current age and state of health?
Do you have any injuries? Please describe.
Are you currently on any medications, if so which ones and what for?
Describe your yoga experience (length of time, specific teachers, styles of Yoga practiced), including teaching experience and current classes taught if applicable.
What is your intention for taking this program?
What particular skills, qualities and talents do you bring to this experience?
How do you plan to make the time for studying and practicing your Yoga?
What are your biggest challenges in life? And in Teaching if applicable?
Do you currently see a therapist? Yes No
How will you meet the financial requirements?
Anything else you want to tell me? Questions, comments or concerns.