PURNA YOGA TEACHER TRAINING COURSE: APPLICATION FORM

APPLICATION FOR ADDMISSION

Please complete this application fully. Return it to info@purna.ro along with a recent photo(max 100 kb) and a scan of a psychiatric certificate to demonstrating the applicant is in a healthy state of mind (this should be provided in original at the beginning of the first class). The applicant will be contacted within max 5 days of application submission with notification of PURNA has received his/her application. Students will be notified of acceptance to the program within one week of receipt of their application and must pay the TTC deposit (paid online).

Incomplete applications will be returned to the applicant for completion and re-submission. Incomplete refer to: omitted signature, missing psychiatric certificate scan, missing applicant photo, or verification of heaving read the Criteria for Certification, Terms and Agreement, Payment and Refund Pages, missing answers, etc.

FIRST NAME

FAMILY NAME

GENDER

ADDRESS

CITY & COUNTRY

MOBILE PHONE

BIRTH DATE

MARITAL STATUS

EMAIL

EMERGENCY CONTACT

NAME & SURNAME

PHONE

RELATIONSHIP

CURRENT OCUPATION

YOGA EXPERIENCE

How long have you been practicing Yoga?

If more than one year: how many years?

If you are already a Yoga practitioner, which style do you practice?

Briefly describe your Yoga practice if you have one:

What makes you feel confident that PURNA Yoga style is the one you wish to teach?

Do you have any experience teaching Yoga?

If Yes, how long have you been teaching and which tradition/style?

Please describe any other spiritual or meditation practices which are important to you?

HEALTH INFORMATION

The following will be used by our training staff to better assisting you during the TTC. Your answers will be kept in strict confidence within TTC Administration only, with a view of guiding your individual program. I agree with this.

Are you currently taking medication for any physical or psychological condition?

Do you have any chronic physical limitation or disabilities?

Do you have a history of psychological or emotional illness, or issues?

Do you have a communicable disease?

Have you had a serious illness or major surgery within the last five years?

Are you currently pregnant or trying to become pregnant?

If you answered YES to any question above, please describe with a short explanation. If there is anything else about your physical or psychological health that you feel might affect your participation in the TTC, please explain:

Have you used tobacco, alcohol, recreational drugs, or illicit substances within the last 12 months?

If you answered with yes to the above question, please give details about:

Please list any prescription medication you are currently taking if so, including birth control:

IN-DEPTH

This section of the application is intended to give us a better understanding of you as a person. We encourage you to include any experience or turning points in your life that have brought you to your current relationship with yoga and aspiration to become a teacher. Please give short answers to the following questions:

What attracts you to spirituality and specifically to the path of yoga?

What does yoga mean to you? What should the role of teacher be?

Why have you chosen to apply to become a yoga instructor?

What is it specifically about the PURNA approach to yoga that interests you?

FULL DISCLOSURE

Dana Tupa, the teachers and Studio PURNA Yoga staff must be able to rely on the truthfulness of information provided by applicants. The information an applicant provides on this form is treated as confidential and will only be seen by those teachers and staff involved with the TTC. Before submitting the application to PURNA, it is required that you read the following documents. Your answers indicated that you have carefully read and accepted the terms set forth in each document. I agree with this:

NOTE

Before applying for the PURNA TTC, please take into consideration that an PURNA Yoga Instructor should not smoke, or take recreational drugs or illicit substances. It is mandatory that those who intend to become PURNA Yoga Instructors must quit smoking and/or use recreational drugs before starting the PURNA TTC. Noncompliance with these requirements may provide grounds for expulsion from the program or the withholding of teaching certification. By checking the signature box and by signing below, I affirm that the information provided on this application is true and complete to the best of my knowledge. False, incomplete, or misleading information is grounds for rejection of this application, expulsion for the program, or revocation of certification after completion of the program. By checking this box, I indicate my signature as verification of the statements above

Upon arrival you will be asked to sign these documents for the PURNA's records. Print full first name and surname:

Date: