Minnesota Insitute of Ayurveda Application for Admission to Ayurveda Program Form mnayurveda.com 1/2017

ApplicationforAdmission–AyurvedaProgramApplicationFees-$100duewiththisapplication.$200duewhenacceptedtoprogram.

PersonalInformation

Name(Last)___________________________________(First)____________________________(MI)______

Address___________________________________________________________________________________

City_____________________________________________________State_____________Zip___________

Telephone(cell)______________________________Alternatephonenumber__________________________

DateofBirth_______________________Emailaddress___________________________________________

U.SCitizen/PermanentResident____Yes____No Ifno,pleasecompletethenextsection:

CountryofCitizenship__________________________VisaType_______________IssueDate___________

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CurrentOccupation________________________________________Employer________________________

EmergencyContact:Name____________________________________Telephone#____________________

**************************************************************************************************EducationHistoryDoyouhaveaHighSchooldiplomaorequivalencydocument?_____Yes_____No

Pleasereportanypost-secondary(College/University)educationaswellasanyothercertificateorprofessionaltrainingyouhaveobtained.NameandAddressofSchoolattended Datesyouwereenrolled Degreeyoureceived

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BrieflydescribeyourcurrentAyurvedaandYogapractices.

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Doyouteachyogaorhaveyouevertaughtyogainthepast?Ifso,whatstyleofyoga?Ifyouhavearegularyogapractice,whatstyleofyogadoyouprefer?__________________________________________________________________________________________________

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This Ayurveda program is physically and mentally/intellectually challenging in terms of hours of class time as well as home study.Itisinyourbestinteresttoundertakeself-inquirytodetermineyourabilitytocompletethisrigorousprogram.

Pleasedescribeyouroverallphysicalhealth.Haveyouhadanysurgeriesorchronicillnessordoyouhaveanyphysicallimitation?Pleasedescribehere.

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Pleasefeelfreetotellusanythingelseaboutyourselfyouwouldlikeustoknow.

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We would like to hear about what you hope to learn and achieve from studying Ayurveda.

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Wewouldalsoliketohearaboutyourplansfollowingcompletionoftheprogram,ifany.

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Minnesota Institute of Ayurveda Application for Admission to Ayurveda Program Form mnayurveda.com 1/2017

Minnesota Institute of Ayurveda Application for Admission to Ayurveda Program Form mnayurveda.com 1/2017

IdeclarethattheinformationIhavesubmittedforthisapplicationistruetothebestofmyknowledge.

Signature______________________________________________________Date______________________

Print this application and mail it along with the $100 application fee to: Minnesota Institute of Ayurveda 2637 27th Ave. So. Suite 224 Minneapolis, MN 55406