227 West 13th Street, New York, NY 10011 212.929.0585 www.iyiny.org

200-Hour Teacher Training Application

PLEASE CHECK SESSION: SPRING FALL SUMMER INTENSIVE

Applicant Information

Name AKA First, Last Name you’d prefer to be called in class

Address

City State Zip Country

Phone: Home Cell Work

Email Occupation

Date of Birth Age Sex

Health, injuries or dietary restrictions? (specify below)

Yoga Experience

How long have you practiced yoga?

Where have you practiced over the previous six months?

How many classes do you take in a month?

Have you taken any Integral Yoga classes, retreats or programs? Yes No

If yes, how long have you practiced Integral Yoga style?

Do you practice meditation? Yes No

If yes, regularly since: Meditation method

Have you been involved in any capacity with an Integral Yoga Institute or with Satchidananda Ashram? (If yes, please describe)

If you have practiced other yoga styles, please specify below:

How did you hear about the Integral Yoga Teacher Training program? Check all that apply.

Google Facebook Ad or Event Instagram Friend Poster IYI Newsletter IYI Program Guide Other ____________

227 West 13th Street, New York, NY 10011 212.929.0585 www.iyiny.org

References Please provide us with two references we may contact. References

you provide should not be family members or friends.

Name How do you know this person?

Email Phone

Essay

On a separate page, please describe briefly your personal and occupational background as

well as the spiritual background that may have influenced you to apply for Integral Yoga

Teacher Training. Please indicate your special talents and skills.

Payment

Non-refundable deposit of $250 enclosed:

Check Payable to Integral Yoga Institute

Credit Card MasterCard Visa American Express

Credit Card # ____________________________________________________________________

Expiration Date (MM/YY) _____________________CVC # _________________________

Payment Plan:

No I will pay the balance before the first day of class.

Yes I would like to enroll in the payment plan option.

- Spring and Fall sessions: four-installment payment plan ($100.00) - Summer Intensive session: two-installment payment plan ($50.00)

Payment plan installments will be divided into equal payments throughout the course of the training. Due dates will be set by the training administrator and announced on the first day of class. There is a one week grace period for payment of each installment. Payments that are more than one week late will incur a lateness fee. Completing payment of tuition is a requirement for certification.

227 West 13th Street, New York, NY 10011 212.929.0585 www.iyiny.org

Admission and Continuation Policies

Admission ProcessAcceptance to the Basic Teacher Training Program is conditional on the applicant having at least six months of regular Yoga practice and having taken at least ten classes at Integral Yoga Institute. Exceptions may be made at the discretion of the trainers. A completed application form, a deposit of $250 and a personal essay are also required as is an interview with one or more of the trainers. The rigorous nature of the program, the expectations for success, requirements for both certification and for an invitation to teach at Integral Yoga will all be explained in detail to the applicant in the interview. Together the applicant and the trainers will assess whether the training is appropriate, whether successful completion is likely and whether the time is right for participation. If an applicant is not accepted to the program, $200 of the deposit will be refunded.

Probation PeriodDuring the first week of the program, the trainers may see, based on their many years of experience, that it is simply not workable for the participant to continue. On these very rare occasions, Integral Yoga Institute reserves the right to ask that trainee to leave the program. An explanation will be given by the trainers. Payments will be refunded, less the $250 deposit. If in the first week, a trainee decides not to continue in the program, a refund less the $250 deposit will be given. All refunds are contingent on the return of the training manual and other materials. Withdrawal later in the program is at the trainee’s discretion and there will be no refund.

ContinuationAt any time during the program, at the discretion of the trainers, a trainee may be given awritten warning on areas necessary for improvement, with suggestions on how to improve, in order to continue in the training. If improvements do not ensue, the trainee may be asked to leave the program. A partial refund will be worked out depending on length of time in the program.

Agreement

I wish to apply as a Teacher Trainee, and I agree to assume full responsibility for any injuries

to me that may occur during the training. I am in good health, and any physical illnesses or

ailments are clearly stated above.

I have read and agree to abide by the policies for admission and continuation of the training program as stated above. I acknowledge agreement to fulfill all my teacher training requirements to meet Integral Yoga Institute and Yoga Alliance standards in order to receive my certification. I further acknowledge that Integral Yoga Institute reserves the right to withhold certification should my efforts not meet its requirements and standards.

Signature Date