APPLICATION FORM
Yoga Therapist Training – 2016 - 2020
Thank you for considering our upcoming Yoga Therapy Training. We look forward to receiving
your application and accompanying (2) letters of recommendation.
Instructions: Please complete all of the questions below, then sign and date this application
form and mail it to the address below, or email to sarahjane@yogacentermpls.com:
Yoga Center MPLS
Attn: Sarah Jane
212 3rd Ave N #205
Minneapolis, MN 55401
All information on this form will be kept confidential. You may include the letters of
recommendation (2) with this application or have them sent directly to us at the above address.
Note: You may also fill out this application form electronically using MS Word and email to
sarahjane@yogacentermpls.com. Just click on the shaded text field next to the question you
wish to answer, then enter the required information. If your response is longer than the space
provided, the form size will adjust automatically.
Today’s Date:
First Name:
Last Name:
Gender:
Date of Birth:
Address:
City:
State:
Zip Code:
Country:
Nationality:
Email:
Home Phone:
Mobile Phone:
Website:
Highest Degree:
Occupation:
How did you hear about this Training Program?
1)
What is your background in, and experience with, yoga? For example, what first
brought you to yoga? When? How has yoga influenced / impacted your life? Please
give specific examples.
2)
Have you completed a 200-hour or 500-hour Yoga Teacher Training? How
would you describe the style of yoga you studied? Which one(s), when and with
whom?
3)
Why have you chosen to apply for this Yoga Therapist Training Program?
4)
What do you hope to gain during, and upon completion, of this program? Both
personally and professionally?
5)
Do you teach yoga? For how long? Please tell us about your teaching experience,
include the type of classes taught, populations worked with, any private teaching, etc.
6)
Describe what you do for your personal practice.
7)
Do you have a primary teacher with whom you work individually? If so, who?
How frequently? When did you start working with her? Please describe your experience
in this area. If not, what are your feelings about working with a primary teacher? Please
describe mentor experiences you’ve had in other areas of your life.
8)
Are you open to undergoing the process of Yoga Therapy yourself? As a yoga
therapist, it is crucial to develop emotional strength and clarity. What kind of support is
available to you to help you nourish and develop these skills?
9)
Do you practice any other healing modality apart from yoga? If so, please tell
us about your involvement in this area. How would completing this Training
complement your other healing interests and practices?
10)
Are you comfortable with multiple evaluation methods? As a student of the Yoga
Well Institute’s Yoga Therapist Training, you will be required to undergo various kinds of
evaluations, including presentations, written tests, oral exams, project presentations,
etc. If you’re not comfortable, please explain why?
11)
Do you have, or have you suffered from, any major health problems? Please
list them and let us know what treatment(s) you are/were undergoing for the same.
12)
How will your resources of time, money, energy and emotional support help
you to complete this training? Remember, in addition, to six modules of four and a
half days each, two hours per week for WebEx modules and one or two hours per week
for homework, you’ll need to complete 150 hours of internship and meet regularly with
your primary teacher. How will you be able to manage your family and other
commitments?
As part of this application, please submit two letters of recommendation. The letters of
recommendation should be from people who have known you for at least two years and who
are able to comment on your character as well as your potential as a yoga therapist.
Please list the names and your relationship with the people recommending you:
First Reference:
Name:
Relationship:
Second Reference:
Name:
Relationship:
Telephone number:
Telephone number:
Best time to call:
Best time to call:
DECLARATION
I declare that I have carefully read the Information Packet and the Application Form for the
Yoga Well Institute’s Yoga Therapist Training, and I am in agreement with the general rules,
policies and ethical guidelines of the same. I understand and accept that at times it may be
necessary to change or modify any of the policies of the Yoga Training Program without prior
notification, before, during or after the Training.
I declare that all of the information provided in this application is true and accurate at the time
of application.
Name printed____________________________________
Signature ____________________________ Date:_______________
Upon receipt of your application materials, we will respond with an email confirmation. If you
do not receive an email confirmation within 7 days please contact us directly to confirm our
receipt of your application. Upon acceptance to the program, a deposit of $850 will hold your
place . Please feel free to contact us anytime.