Mentorship In-take Form

I'm so excited to work with you! Prior to our first scheduled 1:1 meeting, please complete this intake form to help me get to know you and your teaching background a little better.

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Date of birth *

Emergency contact name & phone number *

Name of Yoga Teacher Training/School (include website) *

Date 200hr YTT completed *

If you have completed any other trainings since your 200hr YTT please list below. *

What Yoga books have you read and which books were included in your YTT? *

Have you started teaching? *

no yes, for less than 6 months yes, for more than 6 months yes, for more than 1 year

If you are teaching, what style of yoga & how many classes per week? *

What do you feel are your strengths and weaknesses as a yoga teacher? *

Please describe your personal practice. *

Please list any injuries or limitations *

Where do you practice yoga most often & how long have you been practicing yoga? *

Do you have any specific physical goals? (i.e. to do a handstand, to touch your toes, etc...) *

What is your motivation to participate in this program and what do you hope to get from this mentorship? *

What specific topics you would like to explore during our time together? Please list specific areas in which you would like to expand your teaching skills. *

Describe the teacher you'd like to become. *

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Yoga Mentorship Program

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