LISPY Psychotherapeutic Yoga Training Application

Please complete the following application.

Please note that the application will not be accepted without submission of the application fee.
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Date of birth
Select the program to which you are applying:*
Professional background
What is your educational background?*
Institutions, Degrees, Graduation Years
Please describe professional background and current employment?*
Are you a licensed mental health professional?*
- Yes
- No
If yes, please indicate licensure status and professional experience:
Are you a health care provider?*
- Yes
- No
If yes, please indicate professional licenses and experience.
Yoga background
Please list all of your yoga educational background:*
Yoga Alliance designations*
- none
- RYT-200
- RYT-500
- Other
Please describe your yoga teaching style and number of years teaching, if applicable:
Please describe your personal yoga practice and how long you have been practicing:*
Personal Info
Please describe your mental health regimens
(psychotherapy, yoga, diet, exercise, etc)
Please describe your personal goals for your life:*
(diet, lifestyle, career)
What is your biggest obstacle to achieving these goals?*
What else would you like for us to know about you?
How did you hear about LISPY?*
(referred by, web search, advertisement, etc.)
Name
This field is for validation purposes and should be left unchanged.

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