Himalayan Yoga Tradition Teacher Training Program
Primary Mentor Application Form

First Name:		Last Name:
Address Line 1:		Address Line 2:
City:		State/Province:
Zip/Postal Code:		Country:
Home Phone:		Work Phone:
Mobile Phone:		Fax:
Email Address:		Web Site:
If you have agreed to mentor a particular student, please provide the student's name:
Yoga Alliance or Other Regional Accreditation (e.g. European Yoga Union, etc.):
Organizational Certification(s):
Please describe the duration and nature of your experience as a yoga teacher:
What is your main interest in becoming a mentor to yoga teacher trainees?:
Has your accreditation/certification ever been denied due to an ethical challenge or violation of rules of conduct or have you ever experienced a legal action as a result of your yoga teaching?:		No Yes If Yes, please explain:
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