Sivananda Ashram Yoga Farm Work Study Application

Sivananda Ashram Yoga Farm Work Study Application Form

How many months would you like to participate, approximately?
Date From
Date To:
First Name:
Last Name:
Spiritual Name (if any):
Street Address
City
State/Region (for U.S., use 2 digit abbreviation, i.e. CA for California)
ZIP/Postal Code
Email Address:
Telephone (Day)
Telephone (Evening)
Time Zone
Age
Sex	Male Female
Date of Birth (mm/dd/yyyy)
How did you hear about us?
In Case of Emergency Contact (Name)
Emergency Contact Address
Emergency Contact Telephone
Emergency Contact Relationship	Mother Father SIster Brother Boyfriend Girlfriend Husband Wife Roommate Guardian Other
Emergency Contact: Other Relationship
Education (formal, informal or specialized)
Work Experience/Skills	carpentry/building gardening cooking cleaning plumbing sewing grounds office computers- general web design graphic design accounting car repair other (see below)
Other
Please list three (3) personal references including name, phone number and occupation. Kindly press return after each one.
Are you affiliated to any religious group?	Yes No
If so, which religious group(s)?
Yoga & Meditation Experience? (include names of teacher's systems, and include teacher training dates and locations.
Select how regular your yoga practice is.	Never once a week 2-3 times a week 5-7 times a week a few times per month
Select how regular your meditation practice is.	Never once a week 2-3 times a week 5-7 times a week a few times per month
Do you have any ailment or physical or mental limitations that we should know about?	Yes No
Kindly list any ailment or physical or mental limitations that we should know about.
Are you interested in advancing your practice of yoga postures and meditation?	Yes No
Specifically how would you like to advance your practice?
Do you have a criminal record?	Yes No
If yes to criminal record, please list for what.
Are you currently using any prescription or recreational drugs?	Yes No
If yes to prescription or recreational drugs, please state your history of drug or alcohol use.
Have you ever suffered from any mental illness or been in a mental institution?	Yes No
If so, for what condition?
Do you have any special dietary needs or restrictions?	Yes No
If you have any special dietary needs or restrictions, what are they?
Are you a member or have been part of a Sivananda Ashram or Center?	Yes No
If so, which?
Are you able to work independently and willing to do the duties assigned to you?	Yes No
Are you ready to learn new skills and help in areas you are not familiar with?	Yes No
Are you able to take directions?	Yes No
Are you willing to open yourself to new ideas and teachings?	Yes No
Is there anything else we should know or that you would like to tell about yourself?
Please write a brief explanation of your understanding of Karma Yoga and your reasons for wanting to come to the Ashram, including what you hope to achieve during your stay with us.
I, (insert full name to right)
agree to be a workstudy in a yoga immersion program of the Sivananda Ashram Yoga Farm.	Yes No