Application for Adaptive Yoga Training Online

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Personal Information

Name*

First Last

How would you like to be known in class?*

Preferred Name, Nickname, or Spiritual Name Pronouns

Date of Birth*

MM slash DD slash YYYY

Email*

Phone*

Home Address*

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

My Home and Mailing addresses are the same*

Yes

Mailing Address*

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

Would you like to receive a printed copy of the training manual?*

Yes, please ship the manual to the mailing address above.

No, a digital pdf manual is fine.

Occupation*

How did you find out about this program? Check all that apply.*

IYINY Website

Newsletter – Integral Yoga

Facebook – Integral Yoga

Instagram – Integral Yoga

Internet Search

Yoga Alliance

Yogaville

IYI San Francisco

Integral Yoga Teachers Association (IYTA)

Other

Your Yoga Experience

What is your current level of yoga training experience?*

I have not taken any trainings yet.

200-Hour Certification

300-Hour Certification

500-Hour Certification

800-Hour Yoga Therapy Certification / C-IAYT

Others

Other

When and where did you complete your 200-Hour training? Please include name of school / instructors and date of completion.*

If you have taken any additional training beyond the 200-Hour level, please share the type of training, name of school / instructors, and date of completion.*

Describe your yoga teaching experience, including types of classes, frequency, and how long you have been teaching.*

Do you have any experience working with special populations?*

Why are you interested in taking this training?*

Are you currently enrolled in the Integral Yoga Therapy 800-Hour Certification program?*

Yes

Not yet, but I am interested and considering applying.

No, I am not interested in the 800-Hour Yoga Therapy Certification at this time.

Are you currently teaching at IYINY?*

Yes, I teach a regular weekly class or at least two classes per month

Yes, but I teach less often than twice a month

Scholarship

Partial scholarships may be available when possible. If you would like to be considered for a scholarship, please indicate the basis for your request.

BIPOC

LGBTQ+

Other

Is there anything else you'd like for us to take under consideration in reviewing your request for a scholarship?

Health and Safety Information

This information is requested in order to better serve both you and the Integral Yoga community. Responses will be kept confidential.

Do you have any injury, illness, physical or mental health conditions that may impact your participation in the training?*

Are there any other issues or concerns that you would like the instructors to be aware of?*

Emergency Contact Information

Emergency Contact Name*

First Last

Emergency Contact Methods*

Phone

Phone & Email

Emergency Contact Phone*

Emergency Contact Email*

Agreements

Tuition Policy*

A deposit of $100 is required to reserve your space in the program. The deposit is non-refundable, but will be counted as part of your tuition. This deposit must accompany your application to complete your enrollment.
Full payment of tuition is due before the training begins, unless you are enrolled in the payment plan, in which case your first installment is due before the training begins.
Non-payment of tuition will result in canceled registration from the course.

• $1300 Early Bird Tuition for applications received by August 1, 2023.
• $1395 Full Price Tuition for applications received after August 1, 2023.
• $1275 for IYINY active teachers.

Directions to complete registration with your tuition payment will be emailed to you after your application has been reviewed and accepted.

I have read and agree to the tuition policy.

Admission and Continuation Policy*

Acceptance into the training program is not guaranteed, and is conditional upon the applicant meeting the basic requirements as stated in the training prerequisites. A completed application form and deposit are required to be considered for acceptance. Tuition must be paid in full or actively enrolled in the payment plan before the training begins, otherwise the student may not be admitted to join the class. If an applicant is not accepted into the program, the deposit will be refunded. If the student decides to withdraw their application before the training begins, the deposit fee is non-refundable. Any balance paid beyond the deposit amount will be returned.

After the training begins, any refund of tuition is contingent upon several factors including but not limited to: length of time in the program, reason for withdrawal or dismissal, return of training materials, intention to complete the training at a later date. Applicants acknowledge that refunds after the training begins are not guaranteed, and will be issued in accordance with the Admission and Continuation Policy as stated.

I agree to the Admission and Continuation Policy

Photo and Video Release

I acknowledge that by participating in an online program I may appear in photos or video recordings of the training. I grant to Integral Yoga Institute of New York and its representatives the right to take photographs/video/recordings of me and my property. I authorize Integral Yoga Institute, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree to the terms of the Photo and Video Release

General Enrollment Agreement

I wish to apply as a Teacher Trainee, and I agree to assume full responsibility for any injuries to me that may occur during the training. I am in good health, and any physical illnesses or ailments are clearly stated above. I have read and agree to abide by the policies for admission and continuation of the training program. I acknowledge agreement to fulfill all my teacher training requirements to meet Integral Yoga Institute and Yoga Alliance standards in order to receive my certification. I further acknowledge that Integral Yoga Institute reserves the right to withhold certification should my efforts not meet its requirements and standards.

I agree to the terms of the General Enrollment Agreement

Payment

Select payment method for application deposit:*

Credit or Debit Card

Paypal

Zelle

Deposit*

Price:

Credit Card

Card Details

Cardholder Name

After submitting this application send your $100 deposit fee via PayPal to TeacherTraining@iyiny.org.
Please include your name and the Training you are applying for with your payment. Your application will not be reviewed until the accompanying deposit is received.

After submitting this application send your $100 deposit fee via Zelle to Gopala@iyiny.org.
Please include your name and the training you are applying for with your payment. Your application will not be reviewed until the accompanying deposit is received.

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Adaptive Yoga Training Online Application Form

Personal Information

Your Yoga Experience

Health and Safety Information

Emergency Contact Information

Agreements

Payment

212-929-0585

info@iyiny.org

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