JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
TSY Request Form
TSY classes are offered to organizations using a sliding fee scale to ensure equity and accessibility for our community members. Please complete this form to bring TSY to your organization!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Phone Number
*
Your answer
Occupation
*
Your answer
Organization
*
Your answer
Location (Address / City / State)
*
Your answer
I am requesting:
*
1 TSY class
8-week TSY program
TSY for a special event
Other:
What are the participants' ages? Please check all that apply.
*
Children 5-12 years old
Youth 13-18 years old
Young adults 19-24 years old
Adults 25-64 years old
Early elderly 65-74 years old
Elderly 75+ years old
Required
What is the estimated number of participants per class?
*
5-8
8-12
12-16
16-20
20+
What type(s) of special needs do your participants have, if any? Please check all that apply.
*
Physical
Developmental
Behavioral/emotional
Sensory-impaired
Required
If you selected any of the special needs categories above, please provide any additional information that you think might be helpful for the instructor to consider:
Your answer
Please choose the answer that best describes your participants' experience practicing yoga:
*
Our participants have no experience practicing yoga
Our participants have some experience practicing yoga
Our participants have a wealth of experience practicing yoga
Our participants have a mix of experience practicing yoga (all levels)
Unknown
How do you feel Trauma Sensitive Yoga would benefit your organization?
*
Your answer
Please select an answer that best describes your organization's ability to sponsor this program and support our instructors:
*
Our organization is able to pay $50 per class
Our organization is able to pay $75 per class
Our organization is able to pay $100 per class
Our organization is not able to pay for a class
Please provide any additional comments and/or questions:
*
Your answer
Thank you!
If you have any questions, please contact Kierstin Graham at
kierstingraham@chlink.org
.
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of ChathamHealthLink.
Report Abuse
Forms
