Application (PDF format) - American Viniyoga Institute

American Viniyoga™ Institute
Application for Professional Training Programs
How to Submit Your Application: Please fill out this form and save a completed copy in either .doc or
.pdf format. E-mail the completed application to Dona Robinson, AVI Student Advisor at
[email protected].
Applications can be made at any time. Early application is highly recommended.
Date of Application:___________________________
Personal Information
Name
Mailing Address
City
State
Zip Code
Country
Web site (optional)
Email address that you check regularly
Home Phone:
Mobile Phone:
Check the option for which you are applying:
____ 200 hour – Viniyoga Wellness Instructor (VWI)Training
____ 500 hour - Viniyoga Teacher Training Certification (Sessions 1-4)
____ 300 hour - Viniyoga Studies (Sessions 1-3)
The Viniyoga Therapist Program is only open to graduates of the 500hr Viniyoga Teacher Training programs.
If you have questions about the Yoga Therapy program please contact the student advisor via the information
at the end of this application.
What location?
____200 hour Location___________________(see website for current location options)
____300/500 Hour -West Coast program at Mount Madonna Center, Watsonville, CA
____300/500 Hour - East Coast Program at Yogaville, Buckingham, VA
The following information will help us to get to know you and guide your training.
Your Educational Background: Institutions, Degrees, and Attendance/Graduation Years:
Professional Background and Current Employment:
Are you a Licensed Health Care Professional Yes/No
If yes, please indicate health care profession:
Yoga Educational Background for Yoga Teachers or Yoga Therapists
Are you registered with the Yoga Alliance? Yes No If Yes, Please specify the designation: _______(ie.
RYT-200)
Did you receive Yoga teacher training before Yoga Alliance registration of training programs? Yes
No
Please fill out any of the following sections that are applicable to your yoga educational background and
experience.
Yoga Teacher Training Program (s) Information
School/Program Name
Dates Attended
# of Hours
Yoga Alliance
Registered
Yes
No
Yes
No
Yes
No
Have you participated in Viniyoga studies in a training program other than AVI?
If Yes, please provide more information about that program:
Yes
No
Yoga Therapist Training Program(s): Please describe any Yoga Therapist Training in which you have
participated:
Program/School
Dates attended
# of hours Additional Information
Yoga Practice and Teaching Experience
When did you start practicing Yoga? What type of classes do you take?
If applicable, how long have you been teaching Yoga? What type(s) of classes do you teach?
If you are a teacher, do you work with students on a one-to-one basis? ____Yes
applicable
If YES, please describe:
____No ____Not
Viniyoga Training Interest and Goals
How did you become interested in/hear about Viniyoga?
What are your goals for this professional training?
How do you see your yoga career unfolding?
Please provide any additional Information about you or your background, other professional
credentials and experience, academic background, life experience, and accomplishments that you
would like to share. We look forward to getting to know you well!
Thank you for your interest in the AVI Viniyoga Foundations Program for Teaching and Yoga Therapy
training. Applications are reviewed regularly. Once you are accepted to the program, you will receive
registration information and pre-training study assignments.
QUESTIONS?: Contact Dona Robinson, AVI Student Advisor at [email protected] or call
(317)938-0123 (Central Time Zone).