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1300/500-Hour Professional-Level Yoga Teacher TrainingApplicationJune 2020 May 31, 2021Thank you for your interest in AUM Home Shala’s 300/500-Hour TherapeuticProfessional Yoga Teacher Training. We rely on information provided in this applicationto determine your capacity to participate in and benefit from all aspects of the program.Admission to the program is determined on both a semester and rolling basis.To apply, please do the following:1) Review information on program dates, costs, faculty, curricula, and generalinformation about AUM Home Shala on our website (www.aumhomeshala.org).2) Complete the attached program application in its entirety, including the short-answerquestions. All applications must be accompanied by an Application Fee.3) Read and sign the attached Liability and Media Release forms, and scan and return thecompleted application to my attention at info@aumhomeshala.org, or mail to myattention at:AUM hOMe ShalaAttn: Melinda Atkins, Director3104 Florida Ave.Miami/Coconut Grove, FL 33133Application fee maybe paid online via PayPal, or by check made payable to AUMHome Shala.4) AUM Home Shala will confirm receipt of application and will notify the applicant viaemail or regular mail of admission within two weeks of the date of receipt of theapplication. AUM Home Shala reserves the right to also require a phone interview ifdeemed necessary to arrive at an admission decision.Admissions Criteria1) General requirements: You must be at least 21 years of age, demonstrate Englishlanguage competency and have received a high school diploma or GED.2) Prior coursework/training: Applicants must provide proof of 200-hour yoga teachercertification from a Yoga Alliance–approved school.3) Complete and sign program application. Include a copy of GED or diploma ofhighest degree completed. Submit proof of 200-hour yoga teacher training.Date of application Date received (for office use only)
2Personal InformationFirst name Last name Middle initialName you prefer to be called:Date of birth / / Age GenderCurrent street addressCity State Zip codePermanent street address (if different than above)City State Zip codeDay phone Evening PhoneCell phone E-mailEmergency contact: First name Last nameRelationship to youStreet address CityState Zip code Day phone Evening phoneCell phone E-mailEducationHave you received a high school diploma or GED? (circle one)YesNoPlease circle the highest level of college education completed (number of years) 1 2 3 4Advanced degree (please describe):List schools attended, dates, and degrees obtained:Include a copy of your GED or diploma of highest completed degree with yourapplication.WorkCurrent occupation(s) Number of yearsPast occupation(s) Number of years
3FluencyAre you fluent in English? (circle one) YesNoIf no, please describe your level of proficiency and other languages that you speakfluently:Prior coursework/trainingSuccessful completion of a 200-hour yoga teacher training from a Yoga Alliance–approved school is required for participation in AUM’s 500-Hour Yoga TeacherTraining.Are you a 200-hour certified yoga teacher? (circle one)YesNoIf yes, from what school did you receive your training and when?Include a copy of your certification with your application.Professional Equivalent:Please Include Equivalent Certification for consideration.Interest in AUMHow did you find out about AUM Home Shala’s Clinical Yoga Therapy Program?AUM Home Shala Front Desk during visit, Natural Awakenings ad,Yoga Alliance, Kripalu Yoga Teachers Assoc., IAYT,Brochure, Facebook, Twitter, Instagram, Newsletter,AUM Home Shala website, Web search, Referral, Friend, OtherIn order to help us determine where to best advertise our programs, please indicate whatprint and/or online yoga and wellness publications you read frequently:Interest in Yoga1. Please list yoga practice and teaching experience (length of time, specific teachers,types of yoga).2. Please list any other training or experience that you think is relevant.
43. Why are you interested in enrolling in AUM’s 300/500 Hour Yoga Teacher Training?4. What are your expectations as a student? What do you hope to gain, learn, or work on?5. Specifically, what types of yoga do you mostly teach and to which age group(s)?6. List any other interesting things you think we should know about you.
5Health InformationAre you currently seeing a health-care provider and, if so, what for?Are you taking any long-term prescription or over-the-counter medication?Yes NO if yes, please list the medication and the reason for taking:Do you have or have you had:AllergiesAnemiaAnxiety DisorderArthritis ( Rheumatoid)AsthmaBack PainBladder or bowel control problems Blood ThinnersBroken BonesCancerChest PainsChronic Fatigue Syndrome/Mono Chronic e ProblemsDizziness, vertigo or loss of balance Eating DisorderEpilepsyEye ProblemsGastritis/ulcerGlaucomaHeadachesHearing DifficultyWomen Only:PMS or irregular periodIf you answered yes to any of the above questions, please describe fully.
6Please describe any injuries, surgeries, or other medical healthconcerns:Please ask any questions or voice any concerns that you have about participating in yogaclasses as a part of AUM Home Shala’s 300/500 Hour Yoga Teacher Training Program:Short Answer SectionPlease answer the following questions:1) Explain your interest in becoming a Professional Level Yoga Teacher, including yourpersonal and professional goals in the field.2) Describe your personal experience with yoga philosophy and practice, including adescription of your yoga practice.
73) AUM Home Shala’s 300/500 Hour Yoga Teacher Training is a rigorous program ofstudy involving a commitment to yoga practice, lecture, experiential study, andhomework assignments. After reviewing the curriculum online, what potentialchallenges do you foresee given the intensive nature of this program?4) Please describe your plans for incorporating the training into your personal and/orprofessional life.I acknowledge that all information submitted in this application is true and accurate.Signature: Date:Print Name
8Assumption of Risk/Waiver of Liability and Media ReleaseASSUMPTION OF RISK/RELEASE OF LIABILITY AND INDEMNITYAGREEMENTAssumption of Risk: I recognize the possibility of potential injury that may resultfrom participating in Yoga classes or any other classes at Aum Home Shala (“Shala”).Being fully aware of this risk, I voluntarily choose to participate in Shala programs andaccept all risks associated with that participation. In consideration of being accepted as aYoga student, I on my own behalf, and on behalf of my heirs, administrators, executorsand successors, hereby forever release and covenant not to the Shala, its officers,directors, shareholders, employees, volunteers and all others associated the Shalaincluding Melinda Atkins, from all liability for any and all damages and injuries I maysuffer while under the instruction, supervisions or control the Shala. I hereby fully agreeto individually provide for all present and possible future medical expenses which I mayincur as a result of any injury sustained while participating at or for the Shala.I have read and understand this acknowledgment of policies, risk and waiver of liabilityand I voluntarily affix my name in agreement.Student’s Name (please print)DateStudent’s SignatureIndemnification and Hold Harmless: I also agree to INDEMNIFY DEFEND ANDAum Home Shala, (“Shala”) its officers, directors, shareholders, employees, volunteersand all others associated with the Shala including Melinda Atkins HARMLESS from anyand all claims, actions, suits, procedures, costs, expenses, damages and liabilities,including but not limited, attorney’s fees, arising from, or in any way related to myparticipation in Shala programs, classes and events, except for those arising out of thewillful misconduct and/or gross negligence of the above named parties, as applicable.I have read and understand this acknowledgment of policies, indemnification and holdharmless agreement and I voluntarily affix my name in agreement.Student’s Name (please print)during, and following the protocol.Date
9MEDIA RELEASEAudio and Image ConsentBy attending and participating in all AUM hOMe Shala classes and events, I hereby grantmy permission to AUM hOMe Shala and its officers, directors, shareholders, employees,volunteers and all others associated with AUM hOMe Shala, including Melinda Atkins,to be filmed, audiotaped, or photographed by any means, and grant full use of mylikeness, voice and words without the expectation of compensation.I have read and agree to the above.Student Name (please print)Student SignatureDate
10Enrollment and PaymentI am applying for (Please Check):300/500 Hour Yoga Teacher TrainingTuition: 300/500 Hour Yoga Teacher Training (RYT): 9900.00Application Fee: 100.00Payment Plan Terms for 300/500 Hour Training: Check Payment Plan if applicable2-Payment Plan: 50% to start ( 5,050); balance of ( 5,050) due the first day of thefourth month after course begins. There is a service fee of 200 included.4-Payment Plan: 25% to start ( 2,575), with 3 additional payments of 2,575,00 due the first day of the third, sixth, and ninth month after course begins.There is a service fee of 400 included.6-Payment Plan Terms: 1750 to start, with 5 additional payments of 1750 tobe paid on the first day of every other month after course start. There is a servicefee of 600 included.12-Payment Plan Terms: 925 to start, with 11 additional payments of 925 tobe paid on the first day of every other month after course start. There is a servicefee of 1,200 included.Additional Fees:§ Required text:§ The Yoga Sutras of Patanjali: Commentary on the Raja Yoga Sutras bySri. Swami Satchidananda. Yogaville: Integral Yoga Publications.§ The Living Gita: the Complete Bhagavad Gita: A Commentary for ModernReaders Yogaville: Integral Yoga Publications.§ Hatha Yoga Pradipika by Swami Muktibodhananda§ Always Looking Up, Michael J. Fox’s autobiography§ Students will be required to purchase two manuals from faculty members, at 25each.§ Students are required to carry a current Liability Policy naming AUM HomeShala as a Certificate Holder.Payment InformationEnclosed is a check for (please make check payable to AUM Home Shala)to pay online via PayPal, please visit our website athttp://aumhomeshala.org/trainings
11Mail or Hand Deliver to: AUM Home ShalaAttn: Melinda Atkins, Director3104 Florida Ave.Miami, FL 33133
Application fee maybe paid online via PayPal, or by check made payable to AUM Home Shala. 4) AUM Home Shala will confirm receipt of application and will notify the applicant via email or regular mail of admission within two weeks of the date of receipt of the application. AUM Home Shal
