Teacher Training Application

*Which training are you applying for?
September 12 - Full Time October 3 - Evenings and Weekends

Basic Information

*First Name:

*Last Name:

*Address 1:

Address 2:

*City:

*State:

*Zip:

*Home Phone:

Work Phone:

*Email:

*Date of Birth:

Gender:
Female
Male

*Emergency Contact Name:

Relationship:

*Phone:

*Please attach a recent photo of yourself:

*Briefly describe your educational and occupational background.

Yoga Background Information

*How long have you been practicing Yoga?
I'm new to Yoga
1-2 years
3 or more years

Please describe your current Yoga practice.

What other types of Yoga classes and practices have you participated in?

Describe your meditation or other spiritual practices.

Why are you interested in becoming a Yoga teacher?

How did you hear about Atma Yoga teacher training?
Internet Ad (please provide details below)
Yoga teacher
Friend
Other (please provide details below)

(details from above question)

Health Information

*Are you in medical treatment for any physical or phychological condition?
No
Yes

*Do you have any long-term medical conditions?
No
Yes

*Have you had a serious illness or major surgery within the last 5 years?
No
Yes

*Do you have any chronic physical limitations or disabilities?
No
Yes

Describe in detail any of the above questions where you answered "yes".

Please list any prescription medications you are taking.

Agreement

I agree to abide by the Atma Yoga guidelines during the 30 day program, which include following a vegetarian diet, refraining from the use of alcohol, tobacco or any other intoxicants, and avoiding sexual activity. I realize that if I do not comply, I may be asked to leave the program without a refund. I certify that I am in good health and have no physical or mental ailments, except as may be indicated on this application. I further agree to assume full responsibility for any injuries or damages that might occur to myself or my property during the teacher training.

*Signature (type your full name)

By typing my name, I hereby accept the agreement as stated.

Payment Information

Upon approval of your application, a payment form will be emailed to you. You must pay for the program in full in order to guarantee your space in the training class. We accept credit card payments online, over the phone or via fax. Contact us if you need to arrange other payment options such as cash or check. Thank you for applying for the 2008 Atma Yoga teacher training program.