Advanced Pranayama (In Person) Application

Name*

First Last

Mailing Address*

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

Email*

Enter Email Confirm Email

Phone Number*

Please select the option that applies to you:*

I am an Ananda Yoga Level 1 teacher or Bridge to Ananda Yoga graduate and would like to take this course towards my Ananda Yoga Level 2 certification
I am a yoga teacher certified in another tradition
I am not a yoga teacher and I am not interested in certification, I am only taking this course for personal development

If you are a yoga teacher not certified through Ananda, can you email your certificate to Melody Hansen at melody@expandingligh.org? (Specify NA if you are not a yoga teacher)*

Are you a Kriyaban?*

Yes
No

Which style(s) of yoga do you practice and how long (months and/or years) have you been practicing?*

Which style(s) of Hatha Yoga are you certified to teach?*

Approximately how many hours of teaching experience do you have?*

Are you currently teaching yoga? If so, who are your typical students?*

Are you registered with Yoga Alliance?*

Have you practiced Ananda Yoga? If so, how much? If not, why have you chosen Ananda's training and what do you hope to gain from this course?*

Ananda takes a classical approach to Yoga: as an aid in the quest for Self-realization, for union of soul with Spirit. Although Ananda Yoga Teacher Training takes place in that spiritual context, trainees are not expected to follow Ananda’s spiritual path; we encourage you to grow on your own path. Does this seem like a good fit for you?*

Yes
Not sure

Do you practice meditation? If yes, how often and how long do you practice?*

This is not a prerequisite for the course.

Medical Questionnaire: What is your birthdate? (Day, Month, Year)*

Please briefly describe your current overall health.*

Describe your history (include dates) of back/spine/neck problems, and indicate if you are currently having any issues. Please be specific.**

Describe your history (include dates) of joint problems (knee, hip, shoulder, etc.), including joint repair/replacement surgeries. Please be specific.*

When was the last time your blood pressure was checked and was it normal, high, or low?*

Are you pregnant? If yes, when is your due date?

Are you currently seeing, or have you seen in the last 5 years, a physician or therapist for any physical or mental/psychological conditions? If yes, for what conditions?*

Are you currently taking medication for any physical or mental/psychological conditions? If yes, what medications, for which conditions, and how frequently?*

If you have any learning disabilities, or other special physical or mental/psychological circumstances, please explain below.*

Please check any of the following difficulties you have had and explain relevant specifics in the next question.*

Please explain the above health conditions you checked off in greater detail and with relevant dates.

If you have questions or concerns about your diet, please elaborate in detail. Important Note: Our kitchen offers a varied selection of vegetarian cuisine daily; we can provide dairy-free and wheat-free alternatives, but some special dietary requirements are beyond our ability to accommodate.

Do you smoke? (If you do smoke it is essential that you ONLY smoke in designated areas both for the wellness of our guests and because we are in an extremely high fire danger area.)*

Yes
No

I hereby certify that the above information is correct to the best of my knowledge, and I will continue taking all medications as prescribed by my health care practitioners(s) while staying at The Expanding Light Retreat.*

Yes
No

Please share any other personal information that you feel we should be aware of, or concerns that you may have about this course.

Emergency Contact Name*

First Last

Relationship*

Emergency Contact Phone Number*

Emergency Contact Mailing Address*

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

Are you a Registered Nurse looking to receive CEUs for this course?*

Yes
No

RNs will need to fill out an additional application to begin this process.

How did you first find out about this course?*

If a teacher/friend referred you to this program, may we please have their name so we can thank them?

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