Niroga Yoga Teacher Training programs

Certified Yoga Teacher Training Program Application
Fall 2012 - Spring 2013

NOTE: If you are a person of color and wish to apply for a fellowship, which includes a year of community service after the training, please read about our Integral Health Fellowship (IHF) Program.

Form fields in bold are required

Applicant Information
Name:
Street Address:
City:
State:
Zip Code
Primary Phone:
Home Phone:
Work Phone:
Cell Phone:
Email:
Occupation:
Date of Birth
Sex:
How did you hear about this program?

Emergency Contacts:
Name: Phone:
Name: Phone:
Physician: Phone:

Yoga Experience:
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:
Please describe how regularly you practice at home, and what your personal home practice looks like, particularly within the last 12 months:
Do you intend to take the Deepening Personal Practice (DPP) Module beginning in August 1, 2012?
What styles/traditions of yoga have you practiced?
What style/tradition do you practice now?
Have you taken any yoga training programs or courses?
Are you currently teaching yoga?
How often do you teach yoga?
What styles of yoga do you teach?
How long have you been teaching?
Have you studied yoga philosophy?

Motivation:
Please answer each of the following questions in up to one or two paragraphs per response.
Why do you want to take this training program at this time?
What are your goals and objectives for this course?
Given your current, or future, commitments from August/September 2012-June 2013, how will you create the time and space to achieve your goals for the teacher training program and completely fulfill all of the training requirements?
Do you have any special interests or capabilities that may be relevant?
Please provide any additional information that would be helpful for us to know.

Health Information:
Current health:
Pregnant / How long:
Chronic physical limitation/disability:	Details:
Prescription medications and/or natural remedies (include condition)	Details:
Serious illness or major surgery in the last 5 years:	Details:
Communicable Diseases:	Details:
Current psychotherapy, counseling, or psychiatric treatment for Drug/alcohol addiction or Eating Disorder?	Details:
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.	Details:

Payment Registration ~ $500.00 non-refundable reservation fee is due within seven days of acceptance of application. ~ Note: If you have been accepted into the program, your spot is not guaranteed until receipt of the reservation fee. Due to the high volume of applications we receive, we can not reserve your spot for more than seven days after acceptance. Refund Policy ~ The $500.00 reservation fee is non-refundable. ~ The remainder of your tuition is fully refundable up to five days before the start of training. ~ Within five days of the start of training, there are no refunds. Disclosure and 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 form I hereby declare the above information 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 order to be eligible for certification, students must meet all the requirements of the program and demonstrate the ability to safely and effectively teach yoga. In the event of rejection, expulsion, or revocation of certification, I understand that I am entitled to no refunds, credits, or adjustments.

Niroga Yoga Teacher Training programs

Certified Yoga Teacher Training Program Application Fall 2012 - Spring 2013

Applicant Information

Emergency Contacts:

Yoga Experience:

Motivation:

Health Information:

Payment

Certified Yoga Teacher Training Program Application
Fall 2012 - Spring 2013