LEAP 200 Hour Application
Thank you for your interest in the Leaders Empowered into Action Program. This training will be a remarkable journey for your growth.

When this form has been successfully submitted, you will see the confirmation message: "Thank you for your application. We will be in touch with you shortly.” You will also be emailed a copy of your responses.

We will review applications and reply by email within 5 business days.
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Email *
Name *
First and last name
Street Address *
City *
State / Providence / Region *
Zip / Postal Code *
Phone number *
Birthdate *
Emergency Contact Name & Number *
How did you hear about this training? *
Which of the following communities are you currently part of? Check all that apply *
Depending upon restrictions, there may be opportunities for us to meet in person. Which of the following locations do you prefer? *
Job Title & Employer *
What if any wellness or leadership trainings have you completed? (name and date) *
List three principal commitments in your life currently. (Please list in order of importance.) *
Please state the main reason you are interested in this program. *
What will you use this program for, once you have completed it? *
This program requires the time commitment of attending ALL the scheduled hours as well as coursework which include readings, writing, a regular physical practice, and outreach teaching. These can be completed in an average of 3-6 hours a week. Please explain how you will meet this commitment. *
Is there a specific community that you are part of or would like to impact with your outreach classes? Who are you going to serve and why? *
Describe your level of wellness and what you do to maintain it. *
We will be in a strong physical practice with group work and self-inquiry. Do you have any pre-existing conditions that would impact your participation in the program? Are you currently on any medications or under physical or psychological care? (If yes please explain) *
What, if any, experience do you have with: Meditation/Mindfulness, Breathwork, Self-Inquiry and a physical yoga practice? *
How do you define leadership? *
A copy of your responses will be emailed to the address you provided.
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