Beyond Addiction Instructor Application

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Please complete by filling in all the blanks of this form. If you have questions or comments please email Sat Dharam Kaur at [email protected] or call 519 372-9212

Applicant Information

Legal Name

Spiritual Name

Skype Address

Postal Address

City

Province/State

Country

Zip / Post Code

Phone

Fax

Yoga Centre

Instructor Certification Guidelines

When did you complete your first Beyond Addiction: The Yogic Path to Recovery Program?

Date

Location

Certified Lead Instructor of Course

Have you completed any other Beyond Addiction: The Yogic Path to Recovery Programs?

Program 1:

Date

Location

Certified Lead Instructor of Course

Program 2:

Date

Location

Certified Lead Instructor of Course

Where and when did you teach the 16 yoga modules (including pranayam, kriya, and meditation)?

(Instructors must teach the 16 week yoga modules twice as a series)

Series One:

Date of Series:

Location of Series:

Series 2:

Date of Series:

Location of Series:

Where, when and to whom did you teach the abridged Beyond Addiction: The Yogic Path to Recovery Program, including the psychological work, with some of the psychological work, using the Community Program Manual?

(Instructors must teach this at least once before certifying)

Date of Program:

Location of Program:

Number of Participants:

Are you a general or associate member of KY-WHA (Kundalini Yoga and Wellness Association) and have you attended a minimum of four regional or international KY-WHA Beyond Addiction meetings a year in person or virtually within the last year? This is a requirement for certification as an instructor. *

If yes, Which dates did you attend meetings and where?

Do you agree to abide by the Beyond Addiction guidelines concerning copyright fees and video usage for you and course participants? (ie you will not photocopy the manual but will order copies for students; you will pay a $25 copyright fee and $75 video usage fee per student for materials) unless a different arrangement has been agreed upon. *

Are you are a KRI certified Kundalini Yoga teacher? *

If yes, where and when did you receive your certification?

It is required to have insurance as a yoga teacher.

Insurance Provider

Insurance Policy Number

Insurance Expiry Date

Please scan and email feedback forms to [email protected] from at least 5 course participants with this application. Click here for a sample Community Class evaluation form.

You must also include a 2 hour videotape of yourself teaching one module of the Beyond Addiction curriculum (send via dropbox or private youtube link), along with the $150 fee to review it (send via etransfer or paypal below).

Send e-transfer to [email protected] or click the button below to pay with Paypal.

NOTE: If you have already been assessed teaching a module in person by Sat Dharam Kaur, you do not need to send a video or the fee.

Thank you for your application.

Please Note – completion of these criteria does not guarantee you will be approved as a Beyond Addiction Instructor. Your application will be reviewed and Sat Dharam Kaur or the Certification Review Committee will notify you after reviewing your submission.

If you have any questions please contact Sat Dharam Kaur at [email protected] or call 519 372-9212