Yoga Psychology for Mental Health Providers Program Application

Portland, OR

trainings@sarahjoyyoga.com sarahjoyyoga.com
Certificate Course Application

Yoga Psychology for Mental Health Providers
Dear Applicant,

Thank you for your request for an application for yogajoy's Yoga Psychology for Mental Health Providers Program. We are honored to receive your application.

yogajoy does not discriminate based on race, sex, religion, ethnic origin or sexual orientation.
REQUIREMENTS FOR APPLICATION & ADMISSION
- Completed yogajoy application form.
- Professional degree, training or experience in a relevent health field.
- To qualify for CE Units you must also be licensed in your field.
- Yoga, mindfulness or meditation practice.
GENERAL INFORMATION
Date

MonthDayYear
Date
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Please check any trainings or retreats you have previously attended with Sarahjoy:*

200hr Yoga & Social Justice yoga teacher training200hr amrita yoga teacher training160hr Professional Yoga Teacher Training Part 1Trauma-Informed, Brain-Sensitive Yoga Skills Training Level 1Trauma-Informed, Brain-Sensitive Yoga Skills Training Level 2Breitenbush Hot Springs RetreatNone yet.
Current Occupation:*
Describe your primary occupational history:*
Please list your professional degree(s) and/or license(s):*
*ATTN: social workers, professional counselors, mental health providers, and alcohol & drug counselors: Please let us know if you interested in receiving CE credit for eligible training programs?

YesNo
Please note that CE credits cannot be guaranteed.
Please indicate your professional affiliation(s):

American Psychological Association (APA)National Association of Social Workers (NASW)Addiction Counselor Certification Board of Oregon (ACCBO)Oregon Board of Licensed Professional Counselors and Therapists (OBLPTC)Licensed Marriage and Family Therapist (LMFT)Other
What is your aim for joining this training? (Please list specific goals)
Do you have a home practice? If yes, how many days per week? What does it consist of (length of time, choice of asana)?
Have you taught yoga before? If yes, for how long and in what capacity? (Please list the dates, locations, levels, average class size.)
Please list any other workshops, class series, or events that you have attended with Sarahjoy:*
Should be Empty:

Portland, OR

Certificate Course Application