Name* First Last Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email Mobile Number* Which course dates are you applying for now?* Jan 8 – Jun 4, 2023 The above dates do not work for me. Please add me to your email list for future offerings of this course. Would you like to receive a deck of Ananda Yoga Asana Affirmation Cards? Yes No What year did you graduate the Ananda YTT in person program?*Please tell us your reasons for re-taking Ananda Yoga Teacher Training Online.*How often do you practice Yoga? rarely/seldom often/regularly daily If you're not currently able to practice consistently, please share why. We would like to explore ways to support you with this. Are you currently teaching yoga? yes, in-person yes, online yes, in-person and online no If you're not currently teaching, please share why. We would like to explore ways to support you with this. 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.* Diabetes Stroke Seizures Eye condition Frequent diziness or falls Osteopenia-Osteoporosis Chronic Headaches Asthma Cancer Anxiety/Depression Trauma Abuse PTSD Addiction Substance Abuse Insomnia Other None of the above Please explain the above health conditions you checked off in greater detail and with relevant dates.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 taking the Online Ananda Yoga Teacher Training course.* If you are an international student, are you able to pass an English language proficiency test? Yes No Not sure The introductory webinar for this program will be on Sunday, January 9, 2022, from 9:00 a.m. to 10:30 a.m. PT. Please mark this date in your calendar.* Yes, I will plan on attending. You will need to have a student volunteer student such as a family member or friend to teach, on three different occasions during the course. Please confirm that you can find a volunteer student.* Yes, I will find a volunteer student that I can teach in person. As part of this course, you'll need to acquire a copy of "The Art & Science of Raja Yoga" book by Swami Kriyananda (J Donald Walters). You'll also be assigned some pre-course reading assignments from this book. (There are older and newer versions of this book. Any year is suitable. Amazon has an ebook Kindle version, or you can visit www.crystalclarity.com to order a hard copy.)* Yes, I will purchase the book before the training begins. Yes, I already have a copy of the book. Please share any other personal information that you feel we should be aware of, or concerns that you may have about this course.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?*Ananda.org websiteEmail(s) received from Online with AnandaEmail(s) received from Expanding LightReferral from past graduate of your training programReferral from a friendWeb searchSocial MediaYoga AllianceOtherI have read and understood the Frequent Questions section (including requirements for certification, and the programs refund policy) (see link directly below).* Yes No If you are accepted into the program, please pledge that you will not share any of the course materials with anyone.* Yes, I pledge not to share any course materials with anyone. Ananda Yoga® Teacher Training FAQsTerms & Conditions for Ananda Yoga® Teacher Training Online Participants must agree to the following terms & conditions for this course: a) You will not share the course manual or other course materials with anyone. b) To receive a written letter of completion, a certificate, and/or CE hours for Nurses, depends upon: Satisfactory performance on all assignments (including on-time completion). Full, regular, and meaningful participation in all course activities. The faculty’s assessment of your readiness to teach. c) Course requirements include the following tasks, for which The Ananda School of Yoga and Meditation and Online with Ananda provide limited technical support: Teach Ananda Yoga to a volunteer student for your final video assignment. Make several short videos, and post them on YouTube (or a similar service) under "private" with a password or "unlisted". Videos can be made with a smartphone, tablet, computer, etc.; no special video equipment is required. d) Refund Policy: If you cancel 14 days or more before the start of the program, your payment will be refunded, less a $150 processing fee. If you cancel within 14 days of the start of the program, then 50% of your payment will be refunded, and the remainder will be forfeited. If you cancel more than 14 days after the start of the program, the full program cost will be forfeited. Accept Terms and Conditions* Yes, I accept Terms and Conditions 82667Δ
