Panacea Yoga Studios, llc panacea School of Integrative Health Professional trainings and certifications Yoga Teacher Training Application

Download 63,51 Kb.
Date conversion26.05.2018
Size63,51 Kb.

Panacea Yoga Studios, LLC

Panacea School of Integrative Health

Professional trainings and certifications

Yoga Teacher Training Application

A $50 non-refundable Application Fee, and personal short question/essay must accompany this application.

Name: ___________________________________ Date:________________

Mailing Address: Street: _______________________________________________

City: _____________________ State: ______________ ZIP:____________

Email address: ______________________________

Home phone: _______________________________

Work phone: _______________________________

Cell phone: _________________________________

Date of birth: _______

Emergency Contact:__________________________

Module/ Monthly Session you are applying for:_______________________________


Do you have a: High school diploma: ____ GED:______

College Education Degree: _______ (please name degree or courses)



Previous study in Yoga and or other alternative areas of study?




Please list any major medical or physical conditions you have been treated for in the last five years? ______________________________


Do you believe you are currently physically/mentally capable of attending our Yoga Teacher Training? Yes: ____ No: ____

Criminal history

Have you ever been convicted of a felony or misdemeanor, other than traffic offenses, within the past five years? Yes: ____ No: ____

If yes, please explain:____________________________


Essay questions:

On a separate piece of paper please answer the following questions.

Please submit with your application.

1. What inspires you to learn more within the area of Yoga studies?

2. What is your current yoga practice, personally and or at a studio location, and if so for how long?

3. What are your personal goals and thoughts with this Yoga Training certification? Do you plan to instruct upon receiving a certification, and or is this monthly course module more directed for self enrichment and personal growth?

4. This yoga training is a professional program that meets high standards through a yoga alliance 200hr certification. This program requires commitment. Please see our Yoga handbook in regards to what is expected through this course of study in regards to graduation requirements, conduct policy, fees and tuition. Are you prepared to take on this responsibility in reference to our Yoga handbook policy?

5. (optional scholarship opportunity) Suzanne Imbruno Cobb, owner of Panacea Yoga Studios LLC, and Panacea School of Integrative Health made extensive progress and recovery from a chronic illness that helped fuel her desire and need to help others suffering and enrich their life with the opportunity to share alternative ways to heal through her studio and educational trainings. Learn more about Suzanne’s story at Due to her past illness and what has motivated her to serve others whom suffer; we are more than pleased to announce the opportunity for individuals whom have experienced a chronic illness in the past and or are in recovery from the devastation of illness to share your personal experience and story by essay 3-5 pages with us, and what has motivated you towards a better quality of life, how do you feel you can help others through your experience? This optional essay will give you the opportunity to receive one of our fabulous and generous scholarships towards your educational tuition.

Your Signature below certifies that all the information on this application is true and correct to the best of your knowledge. Falsifying information on this application will be considered cause for dismissal from this program without refund of any monies paid.

You, the potential student, understand that before you can be formally enrolled in any Panacea School of Integrative Health Program you will need to have a phone or personal interview with a faculty member. In addition, upon acceptance you will need to sign an enrollment agreement with a non refundable registration and program deposit of $199, to secure your spot.

We look forward to the possibility and potential of having you join our Yoga Training Program. We are a dedicated Yoga studio and training center offering amazing Integrative educational based needs to further personal growth and overall enrichment in individual lives.

PRINT NAME:______________________________________________________

SIGNATURE: ________________________________

DATE: ____________


Panacea Yoga Studios, LLC

Panacea School of Integrative Health

101 Second Street Hallowell Maine, 04347


The database is protected by copyright © 2016
send message

    Main page