Shakti Initiation500-hour women’s yoga leadership certification

Certification Application ProcessWhat you seek is seeking you ~ Rumi

We are happy you are considering training with us, and the selection process is to support everyone in setting ourselves up for ease, enjoyment and success.

We kindly ask that you complete the following:

1. Review costs, and dates at www.shakti-initiation.com

2. Complete the following application form, sign, and email or mail it to us. If you mail us your application as opposed to electronically submitting it, please email us at info@shakti-initiation.com to let us know the date you mail your application.

Application Mail to:Jovinna ChanShakti InitiationPO Box 1897 Lenox, MA 01240 413-854 7383

3. Include a copy of your 200-hour yoga teacher training certificate and a current photo of yourself.

4. Include a non-refundable $50 processing fee by check to Jovinna Chan or paypal to Pranaji L3C.

We will send you an email confirmation of our admission decision. We reserve the right to request an additional phone interview if this is necessary to arrive at an admissions decision.

NOTE: 2014 on-site housing is limited to 24 people so early registration and payment is advisable.

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General Training Admission Requirements:

1. AGE: You must be at least 18 years of age.

2. LANGUAGE: At this time, you must demonstrate English Language competency as our trainings are in English.

3. PROFESSIONAL STANDING: We are currently focused on training already certified 200-hour yoga instructors with experience teaching as this creates a base competency in leading mindfulness based wellness and movement experiences.

4. PHYSICAL, MENTAL, and EMOTIONAL PREPAREDNESSInstructing yoga requires being an emotional, physical and mental container for others, and you must demonstrate medical and mental-health readiness to fully participate in the demands of the training and role.

In your lightI learn how to love.

In your beauty,how to make poems.

You dance inside my chestwhere no-one sees you,

but sometimes I do,

and that sightbecomes this art

~ Rumi

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Shakti Initiation500-hour women’s yoga leadership certification

Your task is not to seek for love, but merely to seek and find all the barriers within yourself that you have built against it ~ Rumi

Please print or type in BLOCK letters to ensure legibility Date of Application: Date received (office use):

Personal InformationFirst name Last nameName you prefer to be calledDate of birth(m/d/y) Age EmailAddressCity State ZipPhone Website(optional)Cultural background/ethnicity (optional):How did you hear about us?

Emergency ContactFirst and last name:Relationship to you:State or country/time zone:Phone(Day) Phone(Evening)Email:Please ensure before you travel that this person has photos/copies of your passport, travel insurance, primary care insurance, and any prescriptions (glasses, meds).

Education List relevant schools attended and degrees/certifications obtained Schools Degrees/Certifications

OccupationCurrent Occupations (s) # of years

Past Relevant Occupation(s)

Most unusual work experience:

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If you could untie your wings and free your soul of jealousyYou and everyone around you would fly up like doves ~ Rumi

Yoga Education & Teaching ExperiencesAre you a 200hr Yoga Alliance certified yoga teacher? Yes NoDate of Certification:Instructor’s names: Style of Yoga:How long have you been teaching yoga?Are you fluent in English? Yes NoIf no, please describe your proficiency

List the general duration/ frequency at your most/ least active teaching phases. Example:Active Time # classes # students Class content/stylesMost active Summer 15/wk 15 All level, kids, vinyasaLeast active Fall 5/wk 15 Beginners, Seniors

Do you teach private yoga sessions? Yes NoIf yes, how often? Age ranges: Conditions:

Are there any special populations that you teach currently? Yes NoAre there special populations that you are intending to serve in the next year as a consequence of further training?

List other forms of teaching/group facilitation that you have experience with: # of years

Any experience leading workshops (use the back of this page or attach details)

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Personal Yoga Practice# of years of yoga practice: Styles:

Use this chart to approximate the evolution of your personal practice. For example:Type of Practice Early Focus Current Focus Future InterestMeditation None 30min/7days/wk Do a month sitAsana 1984 – 2hr/7days 2hr/1day/wk ScorpionPranayama A little 30min/7days/wk 2hrs/5daysOther Way into dance I like TV now Levitation

Type of Practice Early Focus Current Focus Future InterestMeditationAsanaPranayamaOther

Short answer Briefly share (point form is fine) about the following questions. Please answer in a separate Word, or text document or handwritten:

1. What about this training most motivates you? Why are you called to be a part of this program at this time in your life?

2. Do you have particular areas of interest in terms of yoga or leadership that you are hoping to get out of this training?

3. What strengths do you bring to this community based women’s yoga leadership certification?

4. What potential challenges do you foresee for yourself given the diverse skills, physical demands and intensive nature of being trained?

5. Please describe any plans or visions you may already have for implementing new expressions of yoga and leadership when you return home?

6. Who are your greatest influences or inspirations for your practice of yoga?

7. Name some of your greatest influences or inspirations for your sense of leadership?

Criminal BackgroundYes No

Have you ever been charged or convicted of a felony or lesser crime?Have you ever been incarcerated?If yes, please explain:

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Health InformationCheck any of the following you currently have or have had in your lifetime:

Respiratory Conditions High Blood PressureHeart Conditions Osteoporosis osteopeniaDiagnosed mental health conditions Chemical sensitivitiesEnvironmental or food allergies Any Allergies(stings, peanut, etc)Seizures or strokes Diabetes

Yes NoAre you under medical treatment for any physical/ psychological condition?Are you currently pregnant or potentially pregnant during the training?Have you ever been hospitalized for a psychiatric condition?Do you have chronic pain, physical limitations, or disabilities?Have you had a serious illness or major surgery within the last 5 years?Are you in recovery from an addiction?Have you ever been in treatment for alcohol or substance abuse?Do you have a communicable disease?If you answered yes to any of the above questions, please describe fully.

List any prescription medications you are currently taking, indicating dosage and frequency of intake, and what symptoms/conditions require the medication, excluding birth control or cosmetic prescriptions.

Do you have any medically based food restrictions? We have limited ability to address special food needs during the month – could this be an issue for you in any way?

Hear blessings dropping their blossoms around you ~ Rumi

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Shakti Initiation500-hour women’s yoga leadership certification

I acknowledge that all information submitted in this application is true and accurate.

I understand that incomplete or inaccurate information may result in non-acceptance or dismissal from the training process.

Sign: Name: Date:

Thank you and many blessings,Grace and Jovinna

Before you send in your application, please check the list below Yes No1. Review costs, and dates at www.shakti-initiation.com2. Completed the application form and signed.3. Include a copy of your 200-hour yoga teacher training certificate and a current photo of yourself.4. Include a non-refundable $50 processing fee by check to Jovinna Chan or paypal to Pranaji L3C.

As soon as you are accepted and pay your deposit, the initiation program begins with the following:

1. Adopt a goddessEveryone will adopt one goddess that they will reflect on and share with the group during the course of our month together. We suggest you base your choice on reflection about if there is one facet of yourself you would like deepen, such as compassion, clear righteous fury, abundance...

2. We also require registered participants to join Facebook (you can use a fake goddess name if you are not a member already and it will be a closed group so answers will be as private as facebook can be). We will have fun, inspiring, reflective optional weekly questions that will help us get to know each other better.

3. Stephen Buhner’s beautiful and life changing chapters about the heart in the book The Secret Teachings of Plants is one of the required reading that are central to our training. Pages 1- 158 is required reading to be completed prior to the training. Cyndi Dale’s book The Subtle Body is also a required text.

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