Program Host Application

Type:
  Elementary School
  Secondary School
  Custody Facility
  Other
Other (please specify):
Name of facility or organization:
Location:
Website:
Contact Person(s):
Phone number:
Email: *
Description of organization, facility, or services:
Youth demographic you serve:
Current youth occupancy at site or in program:
Average length of stay for youth:
Does your site currently have a meditation, mindfulness or yoga program in place?
Yes
No
If yes, please describe:
Your primary goals in implementing a New Leaf program:
Type of program request:
  8-12 Week Pilot School Program
  25-30 Week School Program
  45 Week Year-long Program
Do you have any funding available to contribute towards a program?
Yes
No
How many times per week would you ideally like to see classes offered?
Target timeline for program implementation:
How did you hear about New Leaf Yoga Foundation?
Please provide us with any other information that you feel is relevant in the space below:

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Please note, if you submit a program application, it will be kept on file but will not be reviewed until the application process is open again.