Certificate Application


Certificate Application:

Name as you wish it printed on your Yoga Studies certificate of completion:


_______________________________________________________________

Mailing information:


Street _________________________________City ______________________


State ____ Zip ____________Country (if other than U.S.A.) ___________________


Phone: 

Home (____)__________Work (____)__________Cell (____)____________


Email: __________________________________________________________________


Certificate Request (circle one):  200-hour   500-hour   750-hour  1000-hour


Submit Documentation:

attendance (CONTACT HOURS broken down by date, time, daily total, final total - use tracking grid provided for each month)

payment history (list each payment and date)

log of personal practice (date, length of practice and focus)

documentation of a minimum of 50 hours of class attendance with an approved Yoga Teacher in addition to training contact hours (list date, instructor, location of class)

Certificates of Completion will be issued providing all required documentation has been submitted.  


Date:_________________________


Signature: _____________________________________Date:_________________


***Submit completed application and all required documentation to Hosting Studio Director or Program Director for review.


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