Yoga as Resistance Fall 2017 Interest Form
Thank you for your interest in Yoga as Resistance. This program is a 3-week series, taking place Wednesdays from 3:30-5 pm on October 18, November 1, and November 15 (Weeks 3, 5, & 7) in the Cross-Cultural Center Ring Room.

You will receive an email with more information about the program after you complete this interest form. Because space is limited, a submission to this interest form does not guarantee a spot in the program. Spots for the program will be given to those who are first to submit to this form.

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UCI Email
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Phone Number
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UCI Student ID
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What is your expected graduation year?
Why are you interested in this program?
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What do you hope to gain from this program?
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What, if any, is your experience with yoga?
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Please select your response to the statements below.
Strongly Agree
Strongly Disagree
I practice self-care on a regular basis.
I have a self-care action plan.
I have a positive, healthy sense of self.
I have a commitment to social justice.
Will you be able to make all three sessions (April 11, 18, and 25) from 5:30-7 pm?
Are you allergic to oils or strong scents?
Do you have any accommodation needs?
Your answer
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