Application Deadlines

Enrollment is limited due to private and small trainings (no more than eight students at a time). As a result, trainings and programs fill quickly and we recommend that you submit your application as soon as possible. We will accept last minute applications if space is available. In the event that there is no available space, your deposit will be refunded.

Start date of training you are applying for (MM/DD/YYYY):

Program Format:

( )200 Hr Yoga Teacher Training: Intensive Format

( )200 Hr Yoga Teacher Training: Full Intensive Format

( )200 Hr Flexible Program Option

( )300 Hr Yoga Therapy Intensive Format

( )300 Hr Yoga Therapy Flexible Option

Please list the dates of your training and intensives/sessions, if applicable:

Enclosed is my deposit: ( )Yes ( )No

The remaining balance for your program is due no later than 45 days prior to the first date of training (for yoga training programs). Payments may also be made by phone. Please make checks payable to Rachel Hanks, the Training Director.

Please also include driver’s license number, State and expiration date on the front of your check, if applicable.

I hereby authorize my non-refundable deposit payment (if applicable) to the 5th Element Yoga Certification Program listed above, once my application is accepted for training.

I understand that if I fulfill all of the requirements of the program, including 100% attendance, required reading and homework, and in class assessments, I will receive a certificate of completion, which can be submitted to the Yoga Alliance or a prospective employer as evidence that I have completed the certification program. I understand that 5th Element Yoga reserves the right to ask me to leave the program if my behavior is inappropriate, unethical or violates the Yoga Alliance ethical guidelines. Under such circumstances I understand that my tuition will not be refunded.

I further understand that if I cancel at least 30 days prior to the start of the training, my deposit may be transferred toward a future training within one year and my remaining balance will be refunded. If I cancel within the 30 day cancellation policy, I will forfeit my deposit but my remaining balance may be refunded or applied to a future teacher training within one year. Once the program begins, tuition is non-refundable and non-transferable. I further understand that 5th Element Yoga reserves the right to cancel any training for any reason with a 45 day cancellation policy if necessary.

I understand that all 5th Element Yoga Training materials are under copyright protection and cannot be reproduced by me without the permission of 5th Element Yoga. Failure to comply may result in legal action.

I also understand that program accommodations and premises shall be kept in a neat and undamaged physical condition. I shall conduct myself in a manner so as not to deface, damage, impair or otherwise destroy any part of the premises. I shall notify the Training Director of any situation or occurrence that requires maintenance or repairs. In the event that damages to the premises are made by me, I authorize 5th Element Yoga to submit a bill for my review in an effort to recover costs.

I have read and accept the above terms, requirements, housing agreement, and cancellation policy.

Signature X:

Please provide the following information for program acceptance:

(Incomplete information may result in a returned application).

Full Name:

Emergency Contact Information:

Name:

Phone:

Relationship:

Primary Physician:

Phone:

How did you first learn about the 5th Element Yoga Teacher Training program?

Medical History (does not affect acceptance to the program):

1. Briefly describe health challenges, injuries, illnesses, past surgeries, allergies, and any special foods you may require:

2. Please circle any of the following conditions you may be experiencing:

¤ Epilepsy ¤ Diabetes ¤ Pregnancy ¤ HBP ¤ Hernia ¤ Drug Addiction ¤ 

3. Please list any medications you are currently taking:

4. Other aspects that may affect your training:

For the following section, please be as honest as possible. Please do not fear answering NO.

1. If applicable, how long have you been practicing yoga and in what style?

2. Please list previous teachers you have studied with and styles studied:

3. Do you practice meditation and/or pranayama? ( ) Yes ( ) No

4. If applicable, how has yoga affected your life?

5. Are you currently teaching yoga? If yes, for how many years have you been teaching and where do you currently teach?

6. What are your goals or intentions for your training program?

EDUCATION DETAILS

Major Subjects:

High School:

College or University:

Continuing Education:

Post Graduate:

Former Occupations:

Have you done any kind of cleansing or fasting before? Please explain.

Note: It is recommended that you be drug, caffeine and alcohol free at least 3 months before intensive yoga training. Are you currently using any recreational drugs?

Will you have a car during your training? ( )Yes ( )No

Please check all that apply to your training package:

• ( )200 Hour Yoga Teacher Training Intensive: $2600
• ( )200 Hour Yoga Teacher Training Full Intensive: $2600
• ( )200 Hour Flexible Program Option: $2800
• ( )300 Hour Yoga Therapy Intensive Format: $3800
• ( )300 Hour Yoga Therapy Flexible Option: $4000

TOTAL COST OF YOUR PROGRAM:

If paying by check, please include your deposit ($500 for yoga training programs). Balance is due 45 days prior to training.

Credits and refunds are not available for those who do not cancel by the given deadlines, those who do not show up, or those who leave early. You may pay your deposit or balance by check or credit card (Visa, MasterCard, American Express and Discover Card are accepted). Call (480) 784-7944 if paying by credit card.

Upon acceptance to the program, an acceptance letter with your training details will be emailed to you. Airport transportation is available from 4-11pm for arrival dates, and may be scheduled by phone or by email. You can expect to pay $40 for round trip airport transportation.

Free use of yoga mats is also available during trainings. If you would like to purchase a professional and eco friendly mat at a student discount, please bring a form of payment with you.

Blessings and we look forward to meeting you!