Full Legal Name *

Date of birth *

Email *

Phone *

Address

Street Address *

City *

State *

Country *

Postal Code *

Step 2: Academic Foundation

Anatomy & Physiology (A&P) Status:

I have completed 6+ college-level credits.

I have not completed A&P.

I have another taken form of A&P.

If not completed, please provide your plan below:

Step 3: Experience & Motivation

Relevant Background: *

Statement of Purpose: *

Step 4: Unlearning & Coachability

Describe a time you had to set aside an old "truth" to learn a deeper one. How do you handle feedback that contradicts your current knowledge?

Coachability Reflection: *

Step 4: Unlearning & Coachability

Are you prepared to enter this program with a "Beginner’s Mind," remaining fully open to coaching? (This does not mean that you shouldn’t have questions for clarity, but it does mean you should be prepared to have what you have learned in a prior Ayurveda education setting as possibly incorrect.)

Agreement: *

Yes

Step 5: Travel & Residencies

This program requires physical attendance for practical clinical training.

Are you able to travel once per year within the USA for an intensive 1-week residency training?

Yearly Requirement (Years 1–3): *

Yes

Step 5: Travel & Residencies

This program requires physical attendance for practical clinical training.

Are you able to travel twice—once within the USA and once to India—2-weeks each clinical intensives?

Advanced Requirement (Year 4): *

Yes

Step 5: Travel & Residencies

This program requires physical attendance for practical clinical training.

Do you currently hold a valid passport for travel to India, or are you able to obtain one?

Passport Status: *

Yes

Step 6: Financial Readiness

Employment Status: *

Full-time

Part-time

Self-employed

Not currently employed

Step 6: Financial Readiness

Annual Household Income: *

Under $50k

$50k-$90k

$90k-$150k

$150k+

Step 6: Financial Readiness

Residency Budget Acknowledgment:

I understand I'm responsible for residency costs (domestic: $1,500-$2,500; India: $3,000-$5,000)

Do you have the financial stability to sustain these costs over four years?

Financial Commitment:

Yes

Step 7: Final Verification

How many hours per week can you commit to deep study?

Weekly Study Commitment:

5-10 hours

11-15 hours

16-20 hours

20+ hours

Application Fee

Your Signature:

Digital Signature *

Clear

Estimated Completion Time: 5 Minutes

Fill out the Physician Program Application below

Step 2: Academic Foundation

Step 2: Academic Foundation

Step 3: Experience & Motivation

Step 4: Unlearning & Coachability

Step 4: Unlearning & Coachability

Step 5: Travel & Residencies

Step 5: Travel & Residencies

Step 5: Travel & Residencies

Step 6: Financial Readiness

Step 6: Financial Readiness

Step 6: Financial Readiness

Step 7: Final Verification

Application Fee

Your Signature: