Optional: Please Email recent photograph of yourself

4. Primary teacher(s):

5. Prior trainings (if any):

Name: Style: Length: Certification:
Name: Style: Length: Certification:
Name: Style: Length: Certification:

6. Teaching experience (if any):

Location: Begin (mo/yr): End (mo/yr):
Location: Begin (mo/yr): End (mo/yr):
Location: Begin (mo/yr): End (mo/yr):

7. Why are you interested in this program? What are your short and long-term goals?

8. What is Yoga?

Medical Information:

1. List any prescribed medications you are taking or significant medical treatment you are currently undergoing:

2. Is there anything we should know about your health, such as high or low blood pressure, diabetes or low blood sugar, epilepsy, heart problems, depression or anxiety, neck, back, shoulder, wrist or knee injuries?

Note on pregnancy: If you become pregnant after the start of the program, please let us know right away.

Faculty Member Evaluation:

Download & Print Faculty Member Evaluation

This form must be returned with your completed application, along with a $25 non-refundable deposit, in our hands no later than July 20, 2009. Be sure to complete all pages. We’ll consider late applications only if space is available. Please do not leave your application at PYS.

Mail it to:
Piedmont Yoga Studio
ATTN: Caryn Dickman, DY ‘09 Manager
PO Box 11458
Oakland, CA 94611