Teacher Training Application CONTACT INFORMATION Name * First Name Last Name Email * Phone * Country (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Instagram or TikTok Handle * Website * Provide website URL or type N/A if not applicable TRAINING INTEREST Which level are you applying for? * Level 1: Practitioner (500 hours) Level 2: Facilitator (250 hours, must have completed Level 1) Level 3: Teacher (250 hours, must have completed Level 1 & 2) Unsure - I'd like guidance on where to begin How soon are you hoping to begin training? * Right Away - Immediately upon acceptance Soon - Within the coming months (3 - 6 months) Sometime in the future (6+ months away) BACKGROUND & INTENTIONS Why are you being called to this breathwork path? * (Share your heart. There’s no right answer.) Tell us about your experience with breathwork or other healing modalities. * (Have you practiced or trained in yoga, therapy, energy work, etc.?) What do you hope to offer the world through this work? * (How do you imagine sharing breathwork with others?) Have you done any personal healing work (therapy, coaching, somatics, shadow work, etc.)? * Yes No Is there anything we should know about your emotional, physical, or mental health before beginning this training? (Answer only if you feel comfortable.) AVAILABILITY & COMMITMENT Are you able to commit to the full training length and required hours? * Yes No Do you have time in your schedule for weekly practice, study, and integration? * Yes I'm not sure yet Which format do you prefer? * Self-Paced & Live Virtual Self-Paced & In-Person FINANCIAL READINESS Are you prepared to invest financially in this training? * The Japa Breathwork Teacher Training Program is priced per level. Each level offers a hybrid training approach, including self-paced study and the option for live virtual training ($2500) or in-person training ($5000). Yes, I’m ready I’m interested but may need a payment plan I will need to ask my family or spouse for financial approval/ support I'm not ready yet, but will be by the time I start the program Would you like to be contacted about a payment plan or scholarship options? * Yes No FINAL REFLECTIONS What are you most looking forward to in this training? * Is there anything else you’d like to share with Dr. Japa Kullar and the team? Thank you! We will be in touch within 5-7 business days. Best of luck to you.
