TA Program Application - Pacific Center for Awareness & Bodywork

Name*

First Last

Phone*

Email*

Emergency Contact Info*

Teaching Experiences*

Please list any previous relevant or related teaching experiences or work.

Relevant Work Experience*

Please list significant previous &/or current work as a massage therapist, meditator, or psychotherapist.

Motivation*

What is your motivation for training as a teaching assistant?

Challenges*

As you see it today, what are your primary inner obstacles (emotional and belief systems) that limit you living/being your goal(s) now?

Strengths*

What strengths, talents, and/or gifts do you wish to contribute in this training (e.g. bodywork skills, willingness to be present with self and others)?

Signature*

After signing this form, you will be taken to awarenessandbodywork.com/payment/ to pay the $50 application fee. You may also add an additional payment, too. Applying by August 15 gives you $100 off the tuition cost.

Phone

This field is for validation purposes and should be left unchanged.

TA Application