Your Name                 

Your Address            

City State Zip

Telephone                  

Your e-mail address    

Are you applying for the 200-hour VY&M or the SATT certification?

If SATT, in which track are you interested (check one)?
At-Risk Youth & Adults
Youth & Adults in Recovery
Individuals Living with Chronic Pain and Illness

Why do you want to teach this specific population?

Do you have a previous training certificate? If so, from what school? (note: to enter the SATT program, you must hold a 200-hour training certificate)

How long have you been practicing yoga?

Do you have a meditation practice?     
If so, from what tradition?

Why are you interested in Vajra Yoga?

How did you hear about us?

Please tell us a little bit about yourself (your interests, job etc.)

Are you doing the training to teach or deepen your own practice?

Are you applying for a scholarship?    
If so, what amount?

Are you willing to do work-study in exchange for a scholarship?     
If so, what skills do you have that you think we might find useful?

Have you ever taken a class or workshop with Jill?

Anything else you think would be helpful for us to know about you?

Please feel free to add any additional information here. Click "Submit" below to send your application.