Shiva Rea :: Yoga as Conscious Evolution :: Teacher Training Application

Shiva Rea Teacher Training Program Application '08

Please complete this online application with $108 application fee. Allow up to 2 weeks for processing application.

200 or 500 hour Yoga Alliance Certification

Vinyasa Flow Yoga Teacher Training Program with Shiva Rea and Guest Teachers

Program applying for (choose one) 200 hour program
300 hour (if you already have 200 hr cert.)
500 hour program

Section I: Personal Information

Name *

Title

First

Last

Suffix

Address *

Street Address
Address Line 2
City	State / Province / Region
Zip / Postal Code	Country

Work Phone

(###)

###

####

Mobile Phone

(###)

###

####

International Phone (if not in US)

Email *

Current Occupation

Section II: Yoga Teaching Experience

If yoga teacher, how many years? 1 year or less
2 - 5 years
5 years +

What style of yoga do you teach?

Population you would like to teach after this TT: Beginning Level
Mixed Level
Intermediate/Advanced Level

Section III: Required Essay Questions

For 200 hour TT applicants

Brief Essay Questions (for 200 hr applicants)

For 200 hour TT applicants

Why you are pursuing this 200 hr TT program?

For 200 hour TT applicants

For 200 hour TT applicants

What draws you to this style of training and yoga?

For 200 hour TT applicants

For 200 hour TT applicants

Brief paragraph of your yoga background *

For 200 hour TT applicants

For 200 hour TT applicants

Brief Essay Questions (for 300/500 hr applicants)

For 300 and 500 hr TT applicants

Why are you pursuing this Advanced TT program?

For 300 and 500 hr TT applicants

For 300 and 500 hr TT applicants

What specific areas of yoga are you interested in?

For 300 and 500 hr TT applicants

For 300 and 500 hr TT applicants

Brief paragraph of your yoga background *

For 300 and 500 hour TT applicants

For 300 and 500 hour TT applicants

Where did you complete your 200hr training?

For 300 hr TT applicants only

For 300 hr TT applicants only

What tradition/style?

For 300 and 500 hr TT applicants

For 300 and 500 hr TT applicants

Are you YA certified? If yes, which certification?

For 300 and 500 hr TT applicants

For 300 and 500 hr TT applicants

Please list additional certifications

For 300 and 500 hr TT applicants

For 300 and 500 hr TT applicants

Section IV: Intensives completed with Shiva

Please check off all boxes of all intensives already completed with Shiva prior to applying for this program.

Have you taken an Immersion training with Shiva? Summer Immersion
Winter Immersion
Retreat Immersion (India)

Have you taken 200 hr modules with Shiva? Embodying the Flow module
Fluid Power module
Marma Nadi Chakra module
Pathways of the Flow (Anatomy)
Teaching Exploratorium
Vinyasa Conference Intensives

Please check all modules that apply (200 hour program modules)

Please check all modules that apply (200 hour program modules)

Section V: Health Information

Do you have any medical conditions? Yes
No

If yes, please explain briefly

Do you have any injuries? Yes
No

If yes, please explain briefly

Section VI: Emergency contact information:

Name

Title

First

Last

Suffix

Address

Street Address
Address Line 2
City	State / Province / Region
Zip / Postal Code	Country

Phone

(###)

###

####

Email

Section VII: Declaration/Acceptance of Forms

I hearby declare the information in this application to be true and complete. I understand that providing false information is grounds for rejection of this application, expulsion from the program, or revocation of certification.

I've read & accept the certification requirements Yes, I agree
No, I don't agree

I've read & accept the Code of Ethics Yes, I agree
No, I don't agree

Please review online at www.shivarea.com; teacher trainings section- click on "Code of Ethics"

Please review online at www.shivarea.com; teacher trainings section- click on "Code of Ethics"

Initial here (in place of signature)

Date

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