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Yoga Teacher Training Application

Please print or type the entire application.  Thank you.

Complete and send with check (payable to Elena Case) to:

Focal Point Yoga
20 Dunster Drive
Stow, MA 01775

1.        Program Name: Yoga Teacher Training and Certification    Dates: ____________________

2.        Name: ______________________________________________________   Date of Birth: ______

3.        Mailing Address:       ______________________________________________________________

4.   Email Address:       _                                                                                                        

5.        Home Telephone: (         )_________________   Work Telephone: (        )__________________

6.        Occupation  (If you are not currently employed, your vocation, training or profession): __________________________________________________________________________________

7.        Previous YOGA programs taken within the last two years: ________________________________
__________________________________________________________________________________

8.        Previous YTT taken:_______________________________________________________________

9.        Other related Programs/trainings taken: _________________________________________________ __________________________________________________________________________________

10.        Other relevant education and/or training (indicate type, level, length of training: ____________
__________________________________________________________________________________

11.     Are you currently teaching yoga?

NO____      YES____  How many times per week? __________________________________

Series of classes (How many weeks?) _______  Drop in Class ______ Substitute __________

What tradition/style(s)?________________________________________________________

How long have you been teaching? ______________________________________________

Comments: ___________________________________________________________________

12.     Number of years doing Hatha Yoga: ________                                                                  How often:  Daily_________   Weekly:________  Monthly: _________

Generally how long do you practice?    

 ½ Hour:________    1 Hour: _________    1 ½ Hours: __________

How has your involvement changed and developed over time?  What does Yoga mean to you?

13.     Why did you choose YTT at Focal Point Yoga at this time in your life?

14.     What do you hope to learn in this program?  How would you like to grow in this program?

Health Information: Please indicate any conditions that apply to you.

Under medical treatment or supervision for:

Pregnant: _______  Months at time of program  

Comments: _________________________________

Current psychotherapy, counseling or psychiatric treatment for: ______________________________

Physical Handicaps (vision, hearing, movement, etc.)  Nature and extent of limitation: ____________

  Serious illness or major surgery within the last 5 years (heart problems, cancer, etc.)  Conditions and Dates:

Communicable diseases: _______________________________________________________________

Drug or Alcohol Addictions: ____________________________________________________________

Prescription medications (indicate dosage and frequency of intake, in case of medical emergency, to communicate to treatment center) : ______________________________________________________ ________________________________________________

In case of emergency, please contact:

Name:__________________________________________________ 

Telephone: ____________________

Physician: _______________________________________________  

Telephone: ___________________

Therapist: _______________________________________________ 

Telephone: ____________________