Program and dates you are applying for
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Full Name
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First Name
Last Name
Address
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Address 1
Address 2
City
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Zip/Postal Code
Country
Email Address
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Phone
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(###)
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Date of Birth
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Gender
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How did you hear about this program?
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Do you have any experience with the practice of Mantra?
Yes
No
If so, how long have you been practicing and do you currently have a consistent Mantra Practice?
Do you have any experience with the practice of Yoga?
Yes
No
If so, how long have you been practicing and do you currently have a consistent Yoga practice?
Are you a certified yoga teacher, body worker, healer?
If so, please elaborate
Highest Level of Education
High School Degree/GED
Bachelor's Degree
Master's Degree
Ph. D.
Please list schools attended, including colleges and degrees obtained
Please list trainings attended, including yoga teacher trainings, body-mind trainings, massage therapy, etc.
Current and previous occupations
Include how many years employed there
Are you fluent in the English language?
Yes
No
Are there any health concerns we should be aware of that could prevent you from participating fully in this training?
Why have you chosen to participate in the Mantra Teacher Training and Study & Immersion at this time in your life?
Please provide a paragraph or two
Are you familiar with the teachings of Namadeva Archarya (Thomas Ashley-Farrand)?
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If so, please explain in a paragraph or two.
In a paragraph or two, please explain how you plan to incorporate the teachings of this training into your personal and professional life
In what ways do you currently cultivate devotion and honor your spirituality?
Letters of recommendation (optional): If you would like, you may submit a letter of recommendation to help support your application. Criteria for Certification: The powerful teachings available in the 200hr and 300hr (500hr) programs prepare trainees to teach and facilitate mantra, as well as, provide an opportunity for deep personal transformation. We assess eligibility for certification by the standards below: 1) Demonstrate the knowledge and skills needed to effectively teach mantra related practices presented in the training, respectively, and display an understanding of the connections of these teachings to the lineage of Namadeva Acharya (Thomas Ashley-Farrand). 2) The ability to facilitate mantra, using good judgment, demonstrating emotional maturity and stability, integrity and professionalism, to create an environment of safety and compassion for all students. 3) The intention to establish a continued personal practice of mantra and related studies to help deepen awareness and understanding, and help cultivate the experience needed to nurture the ongoing path as a mantra teacher. These assessments will be made during the course of the training. Includes full attendance and participation, completed reading, homework, written assignments, and performance in all practice teach sessions. I acknowledge that all the information in this application is true and accurate. I have read and understand all criteria for certification. Please note that any inaccurate information could result in non-acceptance to the program or dismissal from the training. Signature: _____________________________ Date:____________________ Checking yes below indicates your acknowledgment of the above and takes the place of your signature. We will review your application when received. Please allow one week for a response. Om Peace Peace Peace
