Integrative Yoga Therapy Teacher Training Application Thank you for your interest in the Yoga Teacher Training Program. Please complete all of the following information to the best of your ability. When complete, click the "Send" button at the bottom of the page. We will respond to your application as soon as possible. Personal and Health Information Your Name Date of Birth Occupation Street Address City State Zip Code Daytime Phone Evening Phone: Cell Phone Email Do you check your email regularly? Emergency Contact (name and phone#) Will you need accomodations during the program weekends? Note: If you are registering for the Residential Program, ignore this question. Do you have any physical health concerns? Do you have any emotional or psychological health issues? Are you taking any medications for the above concerns or other conditions? If yes, please list. Program Interest 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 a 4 week class. What population would you like to serve? Note: If you are registering for the Residential Program, ignore this question. 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? Note: If you are registering for the Residential Program, ignore this question. 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?