About the Center: Residency Program Application
Application for Immersion Course
Applicant name:_________________________________
Address:________________________________________________
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Contact telephone:________________________________________
Email:_____________________________________
Age:______ Sex:________ Date of Birth:________________
Education :__________________________________
Languages spoken:___________________________________
Social Security Number:_______________________
Work Experience:_____________________________________________________________________
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Special Skills: ________________________________________________________________________
Physical ailments or limitations:___________________________________________________________
Special dietary needs or restrictions: _______________________________________________________
Emergency contact person, address, phone number, and relationship:
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3 personal references and contact information: _______________________________________________
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Why do you want to be a student-resident at SYVC?
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Yoga/ meditation experience:_____________________________________________________________
Current practice:_______________________________________________________________________
Have you ever been a member of a Sivananda center or ashram? If yes where_________________________
How did you hear about us?______________________________________________________________
Category of immersion course/ payment you wish to follow:______________________________________
Dates of intended stay: _________________________________________________________________
Any other information you feel that we should know: ___________________________________________
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Briefly discuss your understanding of Karma Yoga and what you hope to achieve during your stay at the center/ashram.
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The undersigned has read all the rules and agreements herein and acknowledges having received a copy of said rules and further agrees to be a student-resident in a Yoga immersion program of the Sivananda Yoga Vedanta Center and Ashram.
Immersion course from ……………………. To ………………………….
Date: ………………………………………………
Signature of Student: ………………………………………………………………
Signature of Director: ……………………………………………………………..
Witnessed by: ……………………………………………………………………..
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