Phoenix Rising Yoga Therapy Training Program Application for April 2022 CONTACT INFORMATIONFull Name* First Middle Last Preferred or NicknamePronounsEmail* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Birth Date or AgeStudents must be 18 years or older.PROGRAM & PREREQUISITESProgram you are Applying for:* PRYT Certified Yoga Therapist - IAYT Accredited (complete 4 Semesters) PRYT Certified Level 2 (complete Semesters 1 & 2) PRYT Certified Level 1 (complete Semester 1)Prerequisite: PRYT Essentials course*Choose one of the following. I have completed a Yoga Therapy Essentials course. I will complete a Yoga Therapy Essentials course prior to March 31, 2022.Prerequisite: Professional Experience*Choose one or both. 200 hr Yoga Teacher Certification with 1 year of yoga teaching experience Professional healthcare license (ie: Psychotherapist, Physical Therapist, Occupational Therapist, Massage, etc.)Supporting DocumentsUpload a copy of certificate, letter confirming completion, or appropriate diploma/license for professional experience indicated above. Drop files here or Select filesMax. file size: 50 MB, Max. files: 5.PROFESSIONAL BACKGROUNDEducational LevelStudents must have completed High School or GED.Current OccupationWebsite Professional Yoga Certification Level 200 hr 500 hr Yoga TherapistPlease provide a description of your yoga teaching experience, including when you began.Professional LicensePlease indicate health care field (ie, psychotherapist, nurse, etc.), credential, and license number.Please provide a description of your current health care practice, including your specialties, typical client load, and whether you are in private or group practice.NARRATIVE QUESTIONSPlease provide a description of your personal yoga practice, including when you began practicing.What is your intention in enrolling and what do you hope to accomplish or achieve by taking the Phoenix Rising Yoga Therapy training—personally and professionally?From any experience you have had with Phoenix Rising so far, what was your most significant learning?What would you like faculty to know about you?HEALTH HISTORYPlease check any of the practitioners you are currently seeing for their professional help: Mental Health Practitioner Allopathic Physician Yoga Therapist OtherPlease list any history of addiction, surgeries, major illness, chronic conditions, accidents, injuries; any prescription or non-prescription medication you're taking or using; or anything else that might be relevant to your participation in the program. Please include dates.TUITION & PAYMENTSPlease note the following tuition and payment commitments, depending on the Program for which you are applying.Tuition PRYT Certified Yoga Therapist (IAYT Accredited) - $17,000 PRYT Certified Level 2 - $11,500 PRYT Certified Level 1 - $6,000Tuition does *not* cover: ● Travel to or from the Residential Sessions ● Room & Board at the Residential Sessions ● Any communication/internet service charges ● Applications such as Zoom, Google Meet, etc. ● Any audio-visual tools or services ● Books for required or recommended reading ● Payment for any Yoga Therapy sessions received as part of the Practicum ● Late Fees ● Charges for any additional supervised work that may be required for satisfactory completionDeposit $750No fee is due with this Application, but you MUST create an account (link provided on submission) and save a payment method in order for the Application to be reviewed. A $750 deposit will be charged upon acceptance in order to secure placement. $600 of that amount may be refunded if the student withdraws by end of day February 15, 2022.Payment Options Please contact me about Payment Plan options.Financial Policies* Yes, I have read and understand the Enrollment & Financial Policies available via link below.Readiness/Commitment*Please confirm that you are ready and willing to make all of the following commitments for the duration of the program. I commit to attending required Residential Sessions. I understand that the program can take 10-15 hours per week, including webinars, to stay on schedule. I have the technology and connection speed that allows me to attend zoom meetings without interruption. I commit to a daily yoga & meditation practice (Sadhana).Declaration* I hereby declare that the information in this application is accurate and complete to the best of my knowledge. I understand that misrepresentation of this information constitutes grounds for expulsion from the program or revocation of certification.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.ΔClick here to review Financial Policies
