APPLICATION FOR THE IYENGAR YOGA THERAPEUTICS TEACHER TRAINING PROGRAMWITH MANOUSO MANOS

Please Print Legibly

First Name and Last Name:

Address:

______

Email: ______

Phone: ______

1. Are you a Certified Iyengar Yoga Teacher (CIYT)?Yes / No

If yes:What is your Iyengar Yoga certification level and what year did you receive that certificate?

______

2. If you are not a Certified Iyengar Yoga Teacher, are you planning to take the Introductory Assessment in 2017? Yes / No

3. Name of teacher/mentor (please list the teacher with whom you have the most regular contact):

______

4. Name of the most senior level teacher with whom you study (if different than the teacher listed in your answer to question #4):

______

5. Have you ever studied the therapeutic applications of Iyengar Yoga? Yes / No

If yes, please describe: ______

______

6. Have you ever assisted in a therapeutic yoga setting? Yes / No If yes, please describe where and when:

7. Do you offer a therapeutic or special needs yoga class? Yes / No If yes, please describe where and when:

8. Have you ever had any injuries or conditions that you have addressed with yoga? Yes / No

If yes, please briefly describe how you structured your yoga practice to make it therapeutic for the particular issue. Please provide this information separately on a maximum of one half (1/2) page (12 point font, single-spaced) explanation.

9. Please provide separately a one half (1/2) page personal statement (12 point font, single-spaced) explaining your background, reasons for enrolling in this program and subsequent goals upon completion.

Please submit your applicationand the $25 application fee by September 1st.

Send application to:

Send check (payable to Iyengar Yoga Therapeutics)to IYT, c/o IYILA, 1835 S. La Cienega Blvd., Suite 240, Los Angeles, CA 90035

Unfortunately, we will be unable to review applications until both the application and check have been received.

Application deadline is September 1st. Please plan ahead: late applications will not be accepted. Applications will be reviewed and applicants will be notified of acceptance into the program by October 1st.

Total annual fee: $1,620

Payment: Upon notification of acceptance into the program, one half of the payment, $810 (non-refundable) is due by November 1st. The balance is due by January 9th, 2018. Anyone not submitting payments by the deadlines will forfeit their spot to someone on the waiting list.

The program will consist of Manouso Manos teaching the following three weekend trainings in Los Angeles:

•March 9 ‒11, 2018

•July 13 ‒15, 2018

•November 30 – Dec 2,2018