Niroga Integral Health Fellowship (IHF) Program
Scholarship Application for Niroga Yoga Teacher Training ▪ 2015-2016
Application Deadline is July 26, 2015. We apologize that incomplete and/or
late applications cannot be considered.
IMPORTANT: Before completing this application, please visit Niroga Yoga
Studio (www.nirogacenter.org) and attend two designated teacher training
classes, in 2015. At least one class with BK or Rosalind is recommended.
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Monday - 10:30-11:45am; 7:30-8:45pm
Tuesday - 6:00-7:15pm
Wednesday - 10:30am-12:00pm; 7:30-8:45pm
Thursday - 6:00-7:15pm
Friday - 10:30-11:45am
Applicant Information
Name:
Street Address:
City:
State:
Zip Code
Primary Phone:
Home Phone:
Work Phone:
Cell Phone:
Email:
DOB:
Gender:
Ethnicity:
Fluent Languages:
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Education:
Occupation:
Gross income for 2014:
Expected Gross Income for 2015:
Please list all the people in your Family/Household that you lived with and
financially supported and/or received financial support from in 2014. Include your
spouse/domestic partner, any dependents, and/or anyone who claimed you as a
dependent. Please list their names, relationship to you, and their gross income
for 2014:
Please list all the people in your Family/Household that you currently live with
and financially support and/or receive financial support from. Include your
spouse/domestic partner, any dependents, and/or anyone claiming you as a
dependent. Please list their names, relationship to you, and their expected gross
income for 2015:
How did you hear about this program?
On which dates did you last attend two designated teacher training classes at
Niroga Yoga Studio?
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Please indicate which month you intend to take the Deepening Personal Practice
(DPP) Module: August 2015* or January/February 2016? (Details are available
on Niroga’s website.)
*Taking the DPP in August 2015 is a requirement for IHF participants that have
not had a consistent home yoga practice in the last 12 months.
Emergency Contacts
Name and Phone:
Name and Phone:
Physician and Phone:
Please note that demographic and financial information may be shared with
program funders; all other personal information, including your responses below,
is only for internal use within Niroga Institute and will be kept confidential.
Experience and Motivation
Please answer each of the following questions in up to one or two paragraphs
per response.
Please describe when you began your yoga practice and how your practice has
evolved:
Please describe how regularly you practice with an instructor(s), and anything
relevant about your classes, particularly within the last 12 months:
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Please describe how regularly you practice at home, and what your personal
home practice looks like, particularly within the last 12 months:
Have you taken any yoga training programs or courses?
What motivates you to participate in the IHF Program at this time?
What are your goals and objectives for the IHF Program?
What qualities/strengths do you possess that most support your growth as a
yoga student?
What qualities/strengths do you possess that will most support you in being an
effective yoga teacher?
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How do you think yoga will be able to help you with life challenges?
How do you hope to serve others as a Certified Yoga Teacher?
Please describe the circumstances due to which you need financial assistance to
complete this training program.
Please provide any additional information that would be helpful for us to know.
Please carefully review the training calendar and program requirements (on
Niroga’s website), and seriously consider the following questions:
Given your current, and future, commitments for the next two years (through April
2017), how will you create the time and space to achieve your goals for the IHF
Program and completely fulfill all of the training and volunteer requirements?
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Do you anticipate any events or changes in the next two years (through April
2017) that may affect your ability to fulfill your commitment to consistently
participate in this program, and complete all of the training and volunteer
requirements? If the answer is yes, please elaborate. (Please take into
consideration any possible school/work related plans, travel, relocation outside of
the Bay Area, medical procedure for you or a loved one, plans for a new addition
to your family, etc.)
If accepted into the training program, please indicate which two designated
weekly classes will you attend regularly at Niroga Yoga Studio from September
2015-April 2016?
Are there any current scheduling conflicts, or anticipated events, that will affect
your ability to attend all of the Saturday teacher training sessions, and 4-day
residential retreat? Please review the dates on our website.
Are there any current scheduling conflicts, or anticipated events, that will affect
your ability to attend the mandatory IHF meetings on 8/22/15 and 3/26/16?
Health Information
Current Health Status:
Pregnant / How long:
Chronic physical limitation/disability:
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Prescription medications and/or natural remedies (include condition):
Serious illness or major surgery in the last 5 years:
Communicable Diseases:
Current psychotherapy, counseling, or psychiatric treatment:
Please list any food allergies:
Do you have any concerns about your physical or mental health that may impact
your participation in this program? If yes, please explain any additional support
you might need from Niroga.
Acceptance of Terms
For my safety and the safety of those around me, I agree to refrain from
consuming alcohol or illegal drugs immediately before, and during, any Niroga
Institute classes, trainings, activities, and events.
By submitting this completed form, I certify that the information I have provided
on this application is true to the best of my knowledge. I understand that
misrepresentation of this information constitutes grounds for the rejection of this
application, expulsion from the program and revocation of certification. In the
event of rejection, expulsion, or revocation of certification, I understand that I am
entitled to no refunds, credits, or adjustments. I agree to inform Niroga as soon
as possible of any updates to the information I have provided on this application.
Please submit the following in one E-mail as Microsoft Word Document(s)
and/or PDF attachments to transform@niroga.org no later than July 26, 2015:
1. This completed application.
2. Your current resume (with education and work experience).
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3. Two letters of recommendation from individuals that know you well enough to
write on the following:
 How you can contribute to this program
 Your dedication to your personal growth
 Your ability to follow-through on your commitments
 Your passion to serve the community
All letters of recommendation must include contact information for the individual
making the recommendation.
Please review your application packet carefully. Incomplete and late
applications will not be considered.
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