124 East 40th Street

                             Suite 603

                             New York, NY 10016

                             www.smartworkout.net

                             smartworkout@verizon.net

                             Phone 212.661.1660

                             FAX   212.661.1880

 

 

Pilates Reformer Certification Course Application


Mail your application to:

Smart Workout 124 East 40th Street, Room 603, New York, NY 10016 or Fax: 212-661-1880  

 

Contact Information  please print

 

Name:

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Address:

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City:                                         prov. / state:                  country:                                    postal / zip code:

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Business phone:                                                  Home phone:                              Cell:

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E-mail

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Course Registration

 

Applications must be accompanied by a detailed resume / CV outlining relevant education and experience, two letters

 
of references, and a $400 deposit. Our courses are limited to a maximum of ten people, and applications will be

 

processed on a first-come-first-served basis.

 

Space will ONLY be reserved upon the receipt of all application materials and deposit.

 

Fees for courses do not include required course materials or applicable exam fees. Course fees are due two weeks

 

before course start date. Deposits and course fees, with limited exception, are non-refundable, and non-transferable.

 

Check our website for full details on our refund and cancellation policies.

 

 

Start Date Requested

 

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Payment Method

 

   deposit only     full payment     MasterCard      VISA     AMEX      check     money order

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account number:                                                      exp: 

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name on card:                                                         signature:

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Reference Letters

 

 

Letters should reflect course prerequisites, your teaching abilities and character

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Relevant Education

 

 

Please list related degrees, diplomas, postsecondary or certificate courses and workshops

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Describe anatomy education: Include number of hours, when / where you studies and what topics were covered
(e.g. musculoskeletal, anatomy, biomechanics)              □ college / university course     workshop / other                 

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List related certification (please specify: e.g.  ACE, AFAA)

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Relevant Experience

 

 

Outline your teaching experience (describe subject taught / years teaching)

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Describe your personal experience in dance, yoga, fitness or other body work (how many years / how recently)

Outline your pilates experience (describe who you’ve studied with, when, & where, and for how long)

Indicate Smart Workout, or other.      none        1-10 hrs       10-30 hrs     30+ hrs

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Personal Information

 

Do you have any injuries, (including current or recent pregnancy) or postural issues?

Failure to disclose any injuries, conditions or postural issues prior to enrollment may result in your removal from the course or
the modification of course repertoire for you individually. Please note that we cannot accept applicants who are currently pregnant.

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How did you hear about Smart Workout and its education program?

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What are your personal goals which this program could help you achieve? Are you interested in becoming a
pilates instructor? If so, why?

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Are you using this course to fulfill continuing education credits?       Yes        No    If so, for what organization?

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Are you applying for the workshop-only portion of our program?      Yes        No   

 

Are you applying for full certification?     Yes        No   

 

 

 

 

I hereby certify that the information provided on this application is accurate.

 

I understand that failure to provide accurate information may result in my removal from the certification program.

 

I have included the following:

□ $400 course fee deposit

 

  Two letters of reference

 

  Detailed resume / CV of education / experience

 

Applications that do not include the above will not be processed



Signature:                                                                                              date:

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