2019/20 TCTSY Certification Program Application
Name: *
Gender: *
Pronouns (optional- please answer if it is useful to you):
I am applying to the TCTSY certification program as (please choose one): *
*if a mental health care professional, please clarify (i.e. LCSW, LMHC, RN, etc.):
Address (Country, City, State) *
Email: *
Please indicate where would you like to attend the opening weekend (September 7 & 8, 2019): *
What is your preferred language? *
Please indicate prior training with the Trauma Center Yoga Program (location, month and year): *please note that some prior training in TCTSY is required *
IF A YOGA TEACHER, briefly describe your yoga teacher training (incl. style, number of hours, what you found most helpful from your training, what you found problematic)
IF A YOGA TEACHER, briefly describe any additional training you have had related to yoga and/or trauma
IF A YOGA TEACHER, briefly describe your yoga teaching experience (incl. are you currently teaching yoga, number of hours you have taught, settings, styles, groups or individuals)
IF A YOGA TEACHER, briefly describe your personal yoga practice
IF YOU ARE A MENTAL HEALTH CARE PROFESSIONAL, briefly describe your training, including any trauma-specific components
FOR ALL APPLICANTS, Please let us know why you would like to be a certified, Trauma Center Trauma-Sensitive Yoga (TCTSY) teacher *
OPTIONAL, Is there anything else that you would like us to know about you?
Disclaimer: I understand that upon successful completion of the TCTSY certification program I will be empowered to facilitate TCTSY 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): *
Please attach your CV/Resume *
Are you applying for the Diversity, Equity and Inclusion Scholarship? *
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