Yogaville Organic Farming Internship Application

Thank you for your interest in the Yogaville Organic Farming Internship. We hope you find the online web application to be convenient. The application is lengthy and detailed; please be sure you set aside enough time to complete the process. Om Shanti, Yogaville Farm

Organic Farming Internship is open to those who have served in at least one of the following:
- as a Living Yoga Trainee (LYT), with the recommendation of the LYT Coordinator
- graduates of an Ashram Integral Yoga Teacher Training.
- Ashram Yogis commited to three (3) consecutive months, with a monthly review,
I have read and understand the prerequisites of this program.*
- Yes! Continue with the application.

Basic Information
Prefered Commitment Period*
- 3 Months
- 6 Months
- 9 Months
- 1 Year
Name*
FirstLast
Preferred Name
Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Phone*
Alternate or Cell Phone
Email*
Age*
Birthdate*
MM
DD
YYYY
Gender*
Occupation
Marital Status
Level of your Hatha Yoga practice*
Level of your meditation practice*

Health Record
The following information is requested in order to better serve you and the Yogaville Staff. If you answer "Yes" to any of the following questions please provide details in the comment box at the bottom of this section. Identify the question in your commentary by its numeric value.
1) Are you under medical treatment for any physical or psychological condition*
2) Are you currently pregnant or trying to become pregnant?*
3) Have you ever been hospitalized for a psychiatric condition*
4) Do you have any chronic long-term medical conditions?*
5) Do you have any chronic long-term physical limitations or disabilities?*
6) Have you had any serious illness or major injury in the last 5 years?
8) Do you have any communicable diseases?*
9) Do you snore?*
7) Do you have any dietary or health restrictions?*
10) Are you in recovery for a drug/alcohol addiction or an eating disorder?*
11) Do you have any hearing or vision impairment?*
Use this space to elaborate on any "yes" answers from the questions above. Please remember to indicate the number of the question.
Describe your weekly alcohol consumption & non-prescription drug use, if any.*
Please list prescription medications you are currently taking - indicate dosage and frequency; omit birth-control and cosmetic prescriptions*

Emergency Contacts
In case of emergency, who would you like us to contact on your behalf?
Name*
FirstLast
Phone*
Alternate Phone or Cell Phone
Your relationship to the person listed above?*
Physician
Physician Phone
Therapist
Therapist Phone

Legal Information
Have you ever been arrested?
Have you ever been convicted of a felony or misdemeanor?
Use this space to elaborate on any "yes" answers from the questions above.
References
Please provide all previous farming references. Please give at least one reference.
Reference #1 Name*
Reference #1 Phone*
Reference #1 Address
Reference #2 Name
Reference #2 Phone
Reference #2 Address
Reference #3 Name
Reference #3 Phone
Reference #3 Address

Programs

Yogaville Organic Farming Internship Online Application

Yogaville Organic Farming Internship Application

Step 1 of 6 - Basic Information

Basic Information

Health Record

Emergency Contacts

Legal Information

References

Personal Questions

Agreement Statement

In this section: