Your Name (required) Street Address City, State, Zip Code Your Email (required) Primary Phone Number (required) Occupation 1. Are You A Kriyaban? YesNo If Yes, with whom and when did you receive it? 2. Have You Taken the SRF Lessons? YesNo If Yes, give the last lesson completed 3. Have you attended at least 2 class series of Golden Lotus Yoga? YesNo If yes, please give teacher’s name and approximate date 4. What previous styles of hatha yoga classes have you taken and for how long? 5. What is your daily home yoga practice, if any? 6. Have you had previous Hatha Yoga Teacher Training? YesNo If yes, when and with what organization? 7. Have you had any meditation training? YesNo If yes, in what tradition(s)? 8. What is your spiritual background? 9. How did you find out about GLSY and our Teacher Training Program? 10. Do you have any special conditions, concerns or physical needs? NOTE: Please attach a short letter stating your reasons for wanting to be trained as a Golden Lotus Yoga Teacher. Feel free to expand any of your answers above by using additional paper. If you have any questions contact: Kaye Thomas-Hogan at 989 348 1722 or firstname.lastname@example.org Sandi Jones at 989 732 6065 or email@example.com Refund Policy: All tuition and fees paid by the applicant shall be refunded if requested within three business days after signing a contract with the school. All tuition and fees paid by the applicant shall be refunded if the applicant is rejected by the school before enrollment. If withdrawal from the training program is before program is completed, the student will get a pro rata refund. All refunds shall be returned within 30 days. Nondiscriminatory Policy: Golden Lotus School of Yoga admits students of any race, color, national and ethnic origin to all rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship programs and other school-administered programs.