Amrita Karma Yoga Program Application Form

Name:_______________________________________________
Address:______________________________________________
City:_________________________________________________
State:________________________________________________
Zip:_________________________________________________
Phone: (home)_________________________________________
      (work)____________________________________________
Age_________________________________________________
M / F_______________________________________________
What is a good time to call you?___________________________
Email address: ________________________________________
Why would you like to be a part of this program?

Are you healthy enough to do heavy physical labor outdoors between 6- 7 hours per day for 35 hours per week? Would you be able to handle the work in a responsible and energetic fashion?   YES / NO

For how long would you like to participate? ____ Weeks _____ Months
What date is convenient for you to start? _________________________
What occupations have you had in the past?
1.

2.

Please list any special skills you have, such as carpentry, painting, or cement work, tractor driving, fork lift or other heavy equipment operations, office work, marketing, graphic design, gardening, truck driving, inventorying, packing trucks or ocean containers?

Are you willing to share a small room with one or more other people (same gender), and to make an effort to get along in our community atmosphere?    YES / NO

Do you currently smoke or use drugs? YES / NO

Are you willing to commit to not using illegal drugs, alcohol, or tobacco and to observing celibacy while you are staying at the ashram?    YES / NO

Do you have any diagnosed medical conditions (physical or mental), for which medications have been prescribed?   YES / NO   If yes, please describe.

Please provide three references by employers: (please do not list co-workers, friends or relatives) and /or your local Amma satsang coordinator where you have performed seva.
Name           Address         Phone/Email         Relationship
1)

2)

3)

Do you have any Special Needs? (i.e. diet, housing, etc.)

Do you have an Automobile?   YES / NO                  Do you have Automobile Insurance?   YES / NO D
o you have Health Insurance?   YES / NO

Please list below the names of 2 people to contact in case of emergency with their phone numbers, addresses and email contact information:
1)

2)

Should you decide to leave the Karma Yoga Program, you may do so at any time for any reason.   Similarly, M.A. Center reserves the right to remove a participant from the program.

I hereby certify that the above information is correct to the best of my knowledge.

Applicant's Signature:__________________________________Date:___________________

Please send this application by email to karmayoga@ammachi.org, by fax to Amrita Karma Yoga at 510-889-8585, or by U.S. Mail to Dayalu, MA Center, P.O. Box 613, San Ramon, CA 94583.

Please also note that completing this application does not guarantee you admission to the Karma Yoga Program.

For questions, please email karmayoga@ammachi.org or call 510-566-4631.