Mentorship Application

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Name*
First Last
Phone*
Date of Birth
Date Format: MM slash DD slash YYYY
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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How long have you been practicing asana? What is your experience with yoga practice?*
Do you currently practice at Refresh?
- Yes
- No
Are you currently teaching yoga?*
- Yes
- No
Where and what do you teach?
What are your teaching goals and what do you hope to gain through working with a mentor?*

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The number of hours per week for this program will vary from student to student, but we do expect a high level of commitment and dependability to make this a success. Are you able to commit to three months of working with your mentor? Please describe examples from now or in the past of your time management skills?*
Please describe your learning style (visual, auditory, tactile, kinetic, mix).
Do you have any physical limitations that may interfere with your ability to complete training?*
Please let us know about any medical conditions or injuries that may affect your yoga practice. Please know that all information is shared in confidence.*
Name
This field is for validation purposes and should be left unchanged.

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