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Confidential Application for the Kintla Yoga Therapy®Training Program
Thank you for your interest in becoming a Kintla Yoga Therapy® (KYT) certified practitioner! Upon completion of Module 1, this confidential application is the next step for potential entry into the KYT Training Program, which involves three levels of certification: KYT Group Session Certification (KYT-GC), KYT Private Session Certification (KYT-C), and KYT Certified Facilitator (KYT-CF)!
The KYT Training Program application and screening process is extensive given that certified practitioners work closely with vulnerable populations. Kintla Yoga, LLC strives for excellence at all levels and sets the highest standards to ensure that the health, safety, and wellbeing of anyone seeking KYT services across the globe is paramount.
To apply for admission to the program, please complete and submit this application along with the non-refundable $30 application fee and three letters of recommendation. If you are admitted to the program, the $30 fee will be applied to your tuition. Upon formal review of the application and the letters of recommendation, a background check will be performed and an in-person or online interview scheduled. You will receive notification of admission status within 14 business days of the interview.
We hope to welcome you to the beginning of this unique and rewarding path of being of service to others in this meaningful way!
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Email address
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What is your preferred language?
English
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Other:
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I am applying for the KYT certification program as a:
Yoga Teacher
Mental Health Practitioner
Both
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Name
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Address
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City
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State
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Zip
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Country
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Phone (mobile)
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Phone (home)
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Email Address
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Occupation
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Date of Birth
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Emergency Contact Name & Phone Number (1)
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Emergency Contact Name & Phone Number (2)
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How did you hear about this program?
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Please list any licenses or certification credentials you have earned that may relate to employment as a KYT practitioner.
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Do you have a 200-Hr. Yoga Teacher Training (YTT) Certification?
Yes
No
When and where (location, studio) did you complete your 200-Hours?
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Do you have yoga teacher training beyond the 200-hr. certification? If so, please explain.
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How long have you practiced yoga?
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What styles/traditions of yoga have you practiced?
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What style/tradition do you practice now?
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Are you currently teaching yoga? If so, how often and where do you teach?
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What styles of yoga do you teach? How long have you been teaching?
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Have you taken any yoga therapy training programs? If so, which one(s), and are you currently practicing yoga therapy?
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Do you have education or training in energy work, healing arts or any other complementary, adjunctive, or integrative medicine treatments?
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Please explain any education or training you have received in traditional medicine and/or mental health. List credentials.
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Please describe any introspective work you have done to date that you would like to share.
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Please explain any education, training and/or personal experience you may wish to share about emotional-psychological trauma.
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Please describe any limitations you may have with regard to working with individuals that have experienced mental/emotional trauma?
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What are your goals and objectives with regard to obtaining a KYT certification?
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Do you have any special interests or capabilities that may be relevant?
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How do you intend to use your KYT certification?
*
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Do you have any concerns about your physical or mental health that may impact your participation in this program or as a KYT practitioner? If yes, please explain any additional support you might need from Kintla Yoga. [Optional]
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Have you ever been convicted of any crime, including sex-related or child abuse related offenses?
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Yes
No
Is there anything else you'd like Kintla Yoga to know?
Your answer
DISCLOSURE AND ACCEPTANCE OF TERMS. By checking the "I accept" box below and submitting this form I hereby declare the above information is true to the best of my knowledge. I understand that misrepresentation of this information constitutes grounds for the rejection of this application, expulsion from the program and revocation of certification. In the event of rejection, expulsion, or revocation of certification, I understand that I am entitled to no refunds, credits, or adjustments.
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DISCLAIMER: I understand that upon successful completion of the KYT-C certification program I will be empowered to facilitate KYT within my scope of practice as a yoga teacher or mental health care professional and that I am NOT becoming a trainer in the model (check one): YES_____ NO_____
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Send me a copy of my responses.
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