Therapeutic Applications of Integral A 300-hour Broad-Spectrum Program

APPLICATION FORM

Hari ! Greetings of Peace! Dear Yoga Teacher,

Thank you for your interest in Therapeutic Applications of . This is the Integral Yoga program for teachers who wish to be grandparented by the International Association of Yoga Therapists. To determine if you are eligible to apply for this program, please refer to the Eligibility Guidelines document at iytherapy.org. The Eligibility Guidelines are stringent and comprehensive. All candidates must submit proof of completion for all teacher trainings, workshops, teaching and experience as described in the application. We cannot provide credit without proper documentation.

Your application, supporting documentation, letter of reference and deposit must be received by mail as one package by Nov. 7, 2013, to be considered. A checklist is provided at the end of this form to assist you in compiling the necessary documents. If you have any questions, please contact by e-mail only program administrator Skiba at [email protected]

May your life be filled with Peace and Joy! The Integral Yoga Therapy Task Force Swami Swami Sarvaananda Rev. Jivana Heyman Sutter Jaymie Meyer Nancy O’Brien Leticia Padmasri

Name ______

Spiritual name if different______

Address ______

______

Email address ______

Phone ______Date of birth ______

I would like to submit this application to: ______Satchidananda Ashram-Yogaville, Buckingham, VA ______San Francisco Integral Yoga Institute ______Integral Yoga Institute of New York, NYC

If additional space is needed, please attach your answers on a separate page, carefully numbering each item to correspond to the questions below.

TRAININGS AND WORKSHOPS 1. Basic 200-hour Yoga Teacher Training:

Year:

Tradition or Program: Location:

Primary Instructors:

2

2. If you did not take Integral Yoga’s 200-hour Basic Yoga Teacher Training, please indicate if your program was approved by Yoga Alliance and briefly describe its emphasis, including exposure to Yogic texts and principals and the opportunity it provided for teaching experience.

3. If you did not take Integral Yoga’s 200-hr. Basic Yoga Teacher Training, please describe your involvement in the Integral Yoga sangha (community), if any.

4. At least one year of regular personal practice is recommended for eligibility for this program. Briefly describe your personal practice.

3

5. List any Integral Yoga trainings you have taken beyond the 200-hour Basic Yoga Teacher Training.

a. Note: please use this grid and an additional page if necessary to also list any hours you have spent assisting other Integral Yoga and non-Integral Yoga teacher trainers.

Primary Training/ Training/Workshop/Assisting Year Location Instructor(s) Assisting Hours

b. Note: please annotate hours you have spent being mentored.

Hours Training/Workshop Year Location Mentor Mentored

4

6. List any non-Integral Yoga therapeutically oriented trainings and workshops. Also list therapeutically oriented hours from trainings and workshops that are not specifically therapeutic in nature.* Please identify any training that was done online. *”Therapeutically Oriented Hours” refers to hours that fall under the categories of the International Association of Yoga Therapists’ Core Competencies, and include: Yoga Foundations, Biomedical and Psychological Foundations, Professional Practice, Teaching and Therapeutic Skills, and Yoga Therapy Tools and Their Application. For more information refer to IAYT Educational Standards for the Training of Yoga Therapists. If you do not know exactly how many therapeutically-oriented hours a training represents, please offer your best estimate with a clear description on a separate sheet of paper.

Primary Training/Workshop Year Location Instructor(s) Therapeutic Hours

5

XXXX

-

XXX -

& .& OR PHONE OR

OR XXX OR

AND/ ;& Client Name Client CONTACT INFO CONTACT

MAIL MAIL - E [email protected]

5 1 TOTAL HOURS

1.5 BY HOUR BY CLASSES LENGTHOF (1.0,1.5, 2.0)

sions,&workshops,&and&mentoring/training&others

1 relating&to&the&therapeutic&applications&of&yoga PER & WEEK TOTAL HOURS TOTAL # TOTAL CLASSES CLASSES

one/private&ses research # 1 10 $ TOTAL be contacted by Integral Yoga to verify your hours. your verify to Yoga Integral by contacted be on WEEKS

1

may

12/12

- 20&hours&can&be& (MO/YR) 10/12 DATE RANGE DATE

Up&to& &

(See$example$row$below.) IYI NY LOCATION

eo,&etc.& Please&include&group&classes,&one

-

-

thecontacts you submit as they

Please notify notify Please WORKSHOPS, Private Sessions Private A&minimum&of&150&hours&is&required.& writing/new&media/vid * GROUP CLASSES, GROUP EXPERIENCE CATEGORY EXPERIENCE TEACHING EXPERIENCETEACHING PRIVATES, MENTORING, ETC. MENTORING, PRIVATES,

7.

6

8. Essay Questions:

On a separate sheet, please answer both essay questions, marking them 8A and 8B. A. Describe how you have used Yoga therapeutically in your teaching practice.

B. How do you plan to use your Yoga Therapy certification? What populations do you wish to serve and why?

9. Reference

Please provide a reference letter from a mentor or senior Integral Yoga teacher. This reference should speak to your ability and interest in using Yoga in a therapeutic way. References can be included here, or mailed directly to Satya Skiba at the address below by Dec. 1. Please specify the following:

Reference from: ______phone: ______

The reference letter is attached ______will be mailed before Dec. 1 ______

10. Payment

_____Application Fee $250.00 Please note: if you are not accepted into the program you will be offered a refund of your fee minus a $54 charge. If you are accepted into the program, $108 will be credited toward the 50-hour Core Course tuition.

If writing a check please make it out to the location where you wish to complete your training: “Satchidananda Ashram”, “S.F. Integral Yoga Institute,” or “New York Integral Yoga Institute.” Check # _____

Credit Card type: Exp. Date: Card Number: Security Code:

7

11. Agreement

I, the undersigned, understand that if I am accepted into this Integral Yoga program and successfully complete it, I still need to fulfill additional requirements set out by the International Association of Yoga Therapists and apply directly to the IAYT for credentialing as a Yoga therapist. Applicant Date: Signature:

CHECK LIST:

_____Application _____Application fee (check or credit card info) _____Copies of certificates and/or letters of proof for each training listed.

_____150 hours of teaching and experience documentation _____Essay questions on separate page _____Reference from a mentor or senior Integral Yoga teacher _____Any additional pages you need to complete this application

_____Copy all and retain one copy for your records Note: please do not send original certificates. Make a copy of everything you send to us including this application and retain for your records in case we need to contact you for clarification. ALL applications must be snail-mailed (no digital applications will be accepted). Please send to: Therapeutic Applications of IY c/o Satya Skiba Integral Yoga Institute 227 West 13th Street New York, NY 10011

Please address all questions via e-mail to: [email protected]

8