Apply to Create a Program!

Note: Yoga Instructor Certification, CPR Training Documentation, and proof of Insurance are required to receive funding.

Download PDF and email to Lynn Medow (lynn@yogabydesignfoundation.org) or apply through this form. Please be aware that if you choose to apply using this form online that you must answer every question, and as the application cannot be saved, it must be completed in one sitting.

Instructor Name *
Instructor Name
Address *
Address
Phone *
Phone
Dates RYT or Equivalent Instructor Certification Valid Through [Please email a copy to jacob@yogabydesignfoundation.org] *
Dates RYT or Equivalent Instructor Certification Valid Through [Please email a copy to jacob@yogabydesignfoundation.org]
Dates CPR Certification Valid Through [Please email a copy to jacob@yogabydesignfoundation.org] *
Dates CPR Certification Valid Through [Please email a copy to jacob@yogabydesignfoundation.org]
Reference able to supply verification of the above *
Reference able to supply verification of the above
Reference Phone *
Reference Phone
Organization Address *
Organization Address
Organization Contact Name *
Organization Contact Name
Organization Contact Phone *
Organization Contact Phone
$
$
Signature *