Note: To send this form by e-mail, highlight the text, cut and paste into a wordprocessor, and send as an attachment.

Residency Program Application

Application for Immersion Course

 

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: ……………………………………………………………………..