Application Form

You are applying for the full program which is either in the US or Thailand: In the US the program consists of two 10 day retreats per year. In Thailand the program consists of one 10 day retreat in 2012 and one 15 day retreat in 2013. There is no partial attendance. Payments will be staggered.

Name (required)
Email (valid email required)
Address (required)
Telephone (required)
Birthdate
Gender Male Female

Describe your regular practice: yoga and/or buddhist and how many days per week, principal practices, and how long you’ve been practicing. Please describe your current method of meditation and how often and how long you usually sit for.

Describe briefly your principal teachers and traditions. Have you studied with any of the teachers from the Insight Yoga Institute? If so, when and for how long?
Have you ever attended a silent mediation retreat? Please list the teachers, dates and locations of these retreats.
You do not need to be a yoga teacher to apply, but if you are a yoga teacher or teacher of other disciplines, how long have you been teaching, how often do you teach, and in what kinds of settings? Please describe what styles and practices you teach. Are you Yoga Alliance certified? Do you have another career?
What about this program interests you?
As this program contains psychological training, we are interested to know if you have had psychotherapy or studied psychodynamic work? If yes, when, what kind, how frequent and for how many years?
Are there any major illnesses you’ve experienced or are recuperating from?
Are you currently on medication? What kind? (This information will be kept in the strictest confidence).
Do you have any ongoing physical conditions? (e.g. Chronic Fatigue, Asthma)
Do you have any special needs or limitations?
Is there anything else you would like us to know?