Heart of Yoga * Teacher Training *  Fall 2017
                                                        APPLICATION FOR 200-HOUR TEACHER CERTIFICATION

Full Name: ______________________________________________ Male: ______ Female: _______
Mailing Address: _________________________________________________________________ ____________________________________________________________________________________ 
Home Phone: ____________________________ Cell Phone: ________________________________
Email Address: ______________________________________________________________________ Date of Birth: _________________
Current Profession: ______________________________________
On a separate sheet, please answer briefly the following questions:

1. When did you begin to study hatha yoga?
2. What yoga classes and workshops have you attended in the last two years?
   (Please include the tradition or style of your training, and approximate hours per week.)
3. Describe your personal practice; how often do you practice, and for how long?
4. Provide any details of previous yoga teacher training you have received.
5. Describe any previous experience you have teaching hatha yoga.
6. How does yoga affect your life?
7. Why do you wish to pursue certification?

Signature: _____________________________________________________ Date: _______________
Payment: $108 non-refundable application fee OR prepay total program fee,

Heart of Yoga 1903 Manakin Road, Ste F, Manakin-Sabot, VA 23103 heartofyogarva@gmail.com 





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