| Are you a 200-hour certified yoga teacher? | Yes, I am a 200-hour certified yoga teacher | ||||||
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| Prerequisites | |||||||
| Have you been teaching Yoga for 1 year or more? (minimum 50 hours) | Yes, I have been teaching for one year (minimum 50 hours) | ||||||
| HTML Block | *** Successful completion of a 200-hour Yoga teacher training from a Yoga Alliance approved school is required for participation in the Integral Yoga Therapy Program track to become a Certified Yoga Therapist. | ||||||
| Home Center | Yogaville, VA | ||||||
| HTML Block | A minimum of one year (minimum 50 hours) teaching Yoga is required for participation in the Integral Yoga Therapy Program track to become a Certified Yoga Therapist. | ||||||
| Name | Mimi Gross | ||||||
| Age | 56-65 | ||||||
| Email hidden; Javascript is required. | |||||||
| Address | 655 NE 61 Street Miami, FL 33137 United States Map It | ||||||
| Phone | 13057888340 | ||||||
| Best days to reach you for your interview |
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| Are you a member of the Integral Yoga Teachers Association | Yes | ||||||
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| Health Information | |||||||
| Do you want to achieve your RYT 500-hour designation during this program? | Yes | ||||||
| Chronic Health issues? | No | ||||||
| Prescription medications and/or natural remedies? | No | ||||||
| Serious illness, injury, or major surgery in the last 5 years? | No | ||||||
| Communicable Diseases? | No | ||||||
| Current psychotherapy, counseling, or psychiatric treatment? | No | ||||||
| Do you have any concerns about your physical or mental health that may impact your participation in this program? | No | ||||||
| Will you require any special accommodations/needs during your participation in the Integral Yoga Therapy program? | No | ||||||
| Any Dietary Restrictions/Choices (Allergies, Vegan, Gluten Free, etc.)? | No | ||||||
| Education | |||||||
| Highest level of education completed | College | ||||||
| Please list schools attended, year graduated, and degrees obtained: |
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| Other work outside of teaching Yoga | |||||||
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| Current occupation(s) and number of years worked - Please list |
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| Past occupation(s) and number of years worked - Please list |
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| Previous Yoga Experience | |||||||
| Prior coursework/training | Successful completion of a 200-hour Yoga teacher training from a Yoga Alliance approved school plus a minimum of one year teaching Yoga is required for participation in the Integral Yoga Therapy Program track to become a Certified Yoga Therapist. If you are not a registered Yoga teacher, but are a licensed social worker or health care professional who would like to supplement your practice with Yoga therapy techniques, you are welcome to join the program, but will need to first complete a basic 200 hour teacher training to be eligible to receive certification from the International Association of Yoga Therapists (IAYT). | ||||||
| When and where did you receive your 200-hour level Basic Teacher Training? | 2018 Prana Yoga | ||||||
| Primary 200hr Instructor | Ma Nithya Lochana Ananda | ||||||
| Have you had a personal practice for at least one year? | Yes | ||||||
| How long have you practiced yoga? Describe your personal practice of yoga and how regularly you practice, including the style/tradition of your current practice: | I have been practicing hatha yoga since 1993 regularly. My current daily practice is consistent with the teachings of Swami Satchidananda, chanting, pranayama, meditation, gratitude, prayer, raja yoga studies, nature walk, and asana. | ||||||
| Do you meditate? | Yes | ||||||
| How long and how often do you meditate? | 30 minutes daily | ||||||
| What other training experience have you had since 200hr teacher training? | Restorative, Kids Yoga, Stress Management, Raja Yoga, Yoga for Arthritis, Ayurveda. | ||||||
| What other styles/traditions of Yoga have you practiced/studied? | restorative and kids yoga (Little Flower Yoga) | ||||||
| Is English your primary language? | Yes | ||||||
| Essay Questions | Please answer the following open-ended questions fully and concisely. | ||||||
| Please describe your past/current Yoga teaching experience including location, timeframe, population taught, etc. | 1.5 hrs. restorative and hatha yoga classes at Prana yoga studio - all population | ||||||
| Which yoga therapy training programs have you taken? | Stress Management | ||||||
| Have you taken any Yoga therapy training programs? | Yes | ||||||
| Do you have any special interests or capabilities that may be relevant? | all things having to do with health | ||||||
| Please list any other training or experience that you think is relevant. | story telling | ||||||
| Please describe your studies and understanding of Ayurveda. | Ayurveda is the sister science of yoga. It is based on constitutions and balancing ones assigned constitution by certain self care rituals and food intake. | ||||||
| Please describe your studies and understanding of yoga philosophy. | I maintain a daily practice of studying the yoga sutras/aphorisms by different commentators. I find that yoga philosophy, at this time, is a manual on how to live a peaceful and healthy life. I also understand as I further my studies I will find deeper meaning. Through my studies I have created rituals that have deepened my spiritual journey. | ||||||
| What are your expectations as a student? What do you hope to gain, learn, or work on? | I want to live the teachings fully. I would like to work on the Ayurveda principals and incorporate them in my life and have a full understanding of these teachings. | ||||||
| Why do you want to enroll in Integral Yoga Therapy Certification (IYTh)? | I enjoy these teachings and have been incorporating them in my life. As an example to my family they as well have picked up on some of these teachings and are incorporating them in their lives. We all agree that we feel better and happier. | ||||||
| How do you intend to use yoga therapy in your practice, both personally and professionally? | I intend to share the teachings with those in need. | ||||||
| Given your current or future commitments, how will you create the time and space to achieve your goals for the IYTh program and fulfill all of the training requirements? | These courses are a priority for me. | ||||||
| List any interesting things you would like to share about yourself | I can't think of anything. | ||||||
| Are there any current scheduling conflicts or anticipated events that could affect your ability to attend any of the scheduled modules? | I have a full time job from 9-5 Eastern. I have been selecting modules that are convenient with my schedule. | ||||||
| Please list three references we can contact regarding your IYTh application. One of these references must be deeply steeped in the Integral Yoga Tradition. Please provide name, position, phone, and email address. | Daisy Gonzalez 305-788-8340 | ||||||
| How did you find out about the Integral Yoga Therapy Certification Program? | Integral Yoga Center | ||||||
| Please provide specific website, studio, or individual names if you can, as well as any other specific information on how you heard about the program | yogaville.com | ||||||
| What print and/or online Yoga and wellness publications you read frequently and what social media you follow for Yoga information? | yogaville e-mails | ||||||
| Agreement | By submitting this form, I hereby declare the above information is true and accurate to the best of my knowledge. I understand that misrepresentation of this information constitutes grounds for the rejection of this application, expulsion from the program and revocation of certification. In the event of rejection, expulsion, or revocation of certification, I understand that I am entitled to no refunds, credits, or adjustments.
I agree to assume all risk of damage or injury that may occur as a student of Integral Yoga Therapy Certification. In consideration of being accepted as a yoga therapy student, the undersigned releases and discharges Integral Yoga, its teachers, and students from any and all claims, demands, actions of any nature, whether present or future, anticipated or unanticipated, known or unknown, that result from the undersigned’s participation in yoga classes or practice of yoga outside of class. | ||||||
| Signature | |||||||
| IYTh Application Fee | IYTh Application Fee, Qty: 1, Price: $108.00 |


