Note: To send this form by e-mail, highlight the text, cut and paste into a wordprocessor, and send as an attachment.
Applicant name:_________________________________
Address:________________________________________________
________________________________________________
________________________________________________
Contact telephone:________________________________________
Email:_____________________________________
Age:______ Sex:________ Date of Birth:________________
Education :__________________________________
Languages spoken:___________________________________
Social Security Number:_______________________
Work Experience:_____________________________________________________________________
___________________________________________________________________________________
Special Skills: ________________________________________________________________________
Physical ailments or limitations:_________________________________________________________
Do you follow a vegetarian diet? ________________________________________________________
Special dietary needs or restrictions: _____________________________________________________
Emergency contact person, address, phone number, and relationship:
___________________________________________________________________________________
3 personal references, relationship, and contact information: ___________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Why do you want to be a student-resident at SYVC?
___________________________________________________________________________________
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: _________________________________________
_____________________________________________________________________________________
Briefly discuss your understanding of Karma Yoga and what you hope to achieve during your stay at the center/ashram.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
The undersigned has read the Resident Agreement 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: ……………………………………………………………………..
