Password Recovery - The Mindfulness Center

I attest that I have a minimum of 1 yr teaching experience and 1 yr personal yoga practice plus the following training and certification for: (Check all that apply.)

If other, please describe:

Personal Information

Emergency Contact (Name and Their Relationship to You)

Emergency Contact (Phone Number)

How did you hear about SOMA Professional Yoga Therapy Training?

If you were referred by a SOMA Yoga teacher or graduate from one of our SOMA trainings, please indicate the teacher and/or graduate's name.

Where did you receive your 200-hour yoga teacher training certification?

What year did you graduate?

How long have you been teaching yoga?

Upload a copy of your Yoga Alliance teacher training certification(s)

Have you received a high school diploma or GED?

Yes No

What is the highest degree or level of school you have completed? If currently enrolled, highest degree received.

Please list schools attended, dates, and degrees obtained:

Please list any mind-body-centered trainings you have completed (e.g., massage therapy, dance, Pilates):

Current Occupation (and number of years in that occupation)

Previous Occupation (and number of years in that occupation)

Any other occupation information you wish to provide?

Are you fluent in English?

Yes No

If no, please describe your level of proficiency: (Please note Yoga teacher training requires each student be able to comprehend and to respond with written and oral communication in English.)

PLEASE ANSWER THE FOLLOWING QUESTIONS:

Personal Health: Please describe any health concerns that may affect your participation in this program. Either mental or physical health concerns may be relevant. Also please describe whether or not you feel these concerns may interfere with your participation in - or the outcomes of this training. If not applicable, please state “N.A.”.

Reason for Attending Training: Why have you decided to pursue Professional Yoga Therapy Training? Please describe the thoughts and feelings behind your motivation to become a certified yoga therapist? Personal experiences, personal growth or other factors are all relevant.

Reason for Attending Training at The Mindfulness Center: Why have you decided to pursue SOMA Professional Yoga Therapy Training, specifically? Please describe your consideration of the SOMA training, and what specifically about our training attracts you?

Future Plans: Once you have completed the training, how do you plan to apply yoga therapy in your life and your work?

Knowledge, Skills and Abilities: What are your greatest strengths as a yoga teacher? Do you have any specific or unique skills and/or abilities that you believe will be of use to you as a yoga therapist? This may include training, education or personal qualities, assets or gifts.

What skills are you hoping to improve by attending this training?

What knowledge are you hoping to gain by attending this training?

What abilities are you hoping to improve by attending this training?

REFERENCES
Please list two persons who can verify your experience as a yoga teacher and a yoga student.:

Reference # 1: (PLEASE LIST: - Name, Phone # and Email Address - How does this person know you? Name of their organization?)

Reference # 2: (PLEASE LIST: - Name, Phone # and Email Address - How does this person know you? Name of their organization?)

POLICY CONFIRMATIONS
Please be sure that you have read and feel able to agree to both the Program Policies and Student Code of Conduct documents linked at the top of this page. Check below to confirm:

Program Policies

Yes, I have read and understand the financial policies. Please read our Financial Policies, available via link at the top of this page, and check this box to indicate acceptance of the conditions and terms therein.

Student Code of Conduct

Yes, I have read and understand the Student Code of Conduct. Please read our Student Code of Conduct, available via the link at the top of this page, and check this box to indicate acceptance of the conditions and terms therein.

I acknowledge that all information submitted in this application is true and accurate to the best of my knowledge. I understand that incomplete or inaccurate information may result in my non-acceptance or dismissal from the program. I acknowledge that I have read the admissions criteria and, should I be accepted to attend the SOMA, Professional Yoga Therapy Training, I understand I will be evaluated using these criteria. (Checking yes below indicates your acknowledgment of the above and takes the place of your signature. )

Yes

Professional Yoga Therapy Teacher Training Application

Personal Information

EDUCATION

WORK

LANGUAGE

PLEASE ANSWER THE FOLLOWING QUESTIONS:

REFERENCES
Please list two persons who can verify your experience as a yoga teacher and a yoga student.:

POLICY CONFIRMATIONS
Please be sure that you have read and feel able to agree to both the Program Policies and Student Code of Conduct documents linked at the top of this page. Check below to confirm:

Personal Information

EDUCATION

WORK

LANGUAGE

PLEASE ANSWER THE FOLLOWING QUESTIONS:

REFERENCES
Please list two persons who can verify your experience as a yoga teacher and a yoga student.:

POLICY CONFIRMATIONS
Please be sure that you have read and feel able to agree to both the Program Policies and Student Code of Conduct documents linked at the top of this page. Check below to confirm:

Company

Information

SERVICES & Programs

Connect with Us

Professional Yoga Therapy Teacher Training Application

Personal Information

EDUCATION

WORK

LANGUAGE

PLEASE ANSWER THE FOLLOWING QUESTIONS:

REFERENCES Please list two persons who can verify your experience as a yoga teacher and a yoga student.:

POLICY CONFIRMATIONS Please be sure that you have read and feel able to agree to both the Program Policies and Student Code of Conduct documents linked at the top of this page. Check below to confirm:

Personal Information

EDUCATION

WORK

LANGUAGE

PLEASE ANSWER THE FOLLOWING QUESTIONS:

REFERENCES Please list two persons who can verify your experience as a yoga teacher and a yoga student.:

POLICY CONFIRMATIONS Please be sure that you have read and feel able to agree to both the Program Policies and Student Code of Conduct documents linked at the top of this page. Check below to confirm:

Company

Information

SERVICES & Programs

Connect with Us

REFERENCES
Please list two persons who can verify your experience as a yoga teacher and a yoga student.:

POLICY CONFIRMATIONS
Please be sure that you have read and feel able to agree to both the Program Policies and Student Code of Conduct documents linked at the top of this page. Check below to confirm:

REFERENCES
Please list two persons who can verify your experience as a yoga teacher and a yoga student.:

POLICY CONFIRMATIONS
Please be sure that you have read and feel able to agree to both the Program Policies and Student Code of Conduct documents linked at the top of this page. Check below to confirm: