200-hr Yoga Teacher Training Online Application "*" indicates required fieldsStep 1 of 250%Today's Date* Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Email* Enter Email Confirm Email Please indicate if you are a healthcare provider, and what typeReferred byHow did you learn about Yoga Health Academy? (check all that apply)* Internet Search Through Inner Peace Yoga Therapy My yoga teacher recommended it (please list teacher's name below) My friend/colleague told me about itPerson's name recommending this programMore About YouHow many years have you been practicing yoga?*How many days per week to you practice yoga?*What style of yoga do you usually practice?Where do you currently practice?Do you have a home practice?* Yes NoWho have been your primary yoga teachers?*Do you practice meditation or pranayama?*Is this your first teacher training or in-depth study?* Yes NoIf no, please list prior trainings:Are you currently teaching yoga?* Yes NoIf yes, where do you teach and for how many years have you been teaching?Why are you interested in this Yoga Teacher Training program?*What are your expectations for this training? What do you hope to achieve at the completion of the program?*Medical HistoryPlease complete the medical history section below so that we can be sure to respond to any emergencies should they occur during your training. Please note that none of your responses will exclude your from being accepted into the program.How would you evaluate your current health? Excellent Good Fair Some challennges(please describe)Do you suffer from any of the conditions below? Epilepsy Diabetes High Blood Pressure No, I do not suffer from the above conditions to the best of my knowledgeExplain any past or present physical injuries that sometimes require yoga modifcationsHow is your current level of stress?Are you pregnant or do you plan to become pregnant during the course of training? Yes NoAre you currently or during the last two years have you been under the care of a physician or mental health care professional?Please list medications you are taking prescribed by your physician or mental health care professional.Payment InformationDeposit* Price: Total Your application will be reviewed within 3 days and you will receive an email response. A $500 deposit is due with your application in order to secure your space in the training. Tuition balance will be invoiced according to option indicated after acceptance into the program. Students must withdraw 30 days prior to program start in order to receive refunds of payments made.
