Naya Ayurveda application form

Name: *

Please enter your full legal name. We'll use this for mailing (via US Postal Service) and for agreements. If you prefer to have a different name on certificates of completion, you may enter that below.

Name on certificate (if different):

Your name as you'd prefer it to appear on any certificates of completion we issue. If the same as your full name as entered above, leave blank. Please note that for US residents, this MUST match your legal name as found on your tax return. The Texas Workforce Commission requires this.

Phone number: *

Either cell phone, home or workphone - list the phone you would like us to call, please

Email: *

The email that will be used for all communication and Virtual Campus Access. Please ensure this is entered correctly.

Date of birth: *

Date of birth (mm/dd/yyyy)

Mailing address
where you would like the Enrollment Packet and Course Materials sent: *

City: *

State/province: *

Zip/postcode: *

Country: *

Do you have a high school diploma?: *

Yes

Previous Education and Experience:

Previous degrees, certificates and/or college credits which may be applicable.

Course category: *

Professional Ayurveda Certificate

Yoga Studies

Self-healing / awareness

Other:

Please select the course category you are interested in applying for

Preferred method of payment: *

I would like to pay fees fully in advance for a 10% discount

I would like to pay fees in quarterly installments for a 5% discount

I would like to pay fees in monthly installments at no interest (credit card required)

Preferred type of payment: *

Paypal invoice

Credit card via phone

Check

Online payment via shopping cart

Please select the preferred type of payment to use.

What is your aim and objective in studying Ayurveda?:

Please note that we accept only 15 candidates for advanced courses. Your answer can help you get priority in a waiting list. This is not applicable to the Foundation courses.

Agreement - please read carefully and indicate whether you agree or disagree: *

I understand that Ayurveda is a complementary health system, not meant to cure, diagnose or treat any disease. All the material provided in this course is for informational purposes and is not recognized by the FDA.

I understand that checking "I agree" and entering my initials below constitutes acceptance of an agreement.

I agree

I don't agree

E-Signature: *

Please sign this application by entering your initials here