Academy Form Full - Main Street Vegan

Academy Application Form

Name you wish to appear on your graduation certificate:*
First Last
Please provide your complete name that you want on your graduation certificate, as well as any professional credentials such as RN, RD, or Ph.D, that you may already have. If you change your name prior to your class, please let us know immediately. We make the certificates as soon as the class is filled and we need everyone's correct name.
Name that you wish to be called
If different from above
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone Number
Work Phone
Cell/Text Phone Number
Email*
Website if applicable
Facebook (Personal and Business)
Instagram (Personal and Business)
Twitter (Personal and Business)
For which dates are you applying?
If not available, a second choice?
Emergency Contact Name
Relationship to you
His/Her Phone Number
Alternate Phone
How did you hear about Main Street Vegan Academy?
Health
Do you have any food allergies or other dietary restrictions? Please state yes or no and then list here the foods you are unable to consume.
NOTE: We can eliminate from our menus all foods to which there are genuine allergies or medical contraindications for any student; we cannot promise accommodate every other preference. Also, if you have an allergy so severe that eating out could be a danger for you, please do not apply for this program.
Describe your personality
(i.e., outgoing, reserved, strong-willed, shy...)
Your Occupation
Education
List any training/certifications in food/health/vegan/animal rights arena.
What sparked your interest in the vegan lifestyle?
How long have you been vegan?
What books and films have influenced you?
Do you smoke?
Do you exercise regularly?
What kind of exercise?
I understand that MSV Academy involves long class days and that I may not be able to exercise as much as usual.
- Yes
Why do you want to become a Main Street Vegan Lifestyle Coach/Educator?
Please choose your preferred payment method below. Once accepted, you'll be sent an invoice that reflects your payment method choice. Either your de-posit or tuition with the discount MUST be received within 30 days of acceptance or your place in class cannot be assured. The discounted tuition rate is available ONLY to those who pay in full within 30 days of acceptance.*
- Payment in full, with $250 discount ($1995-$250=$1745), due within 30 days of acceptance
- Nonrefundable deposit to hold spot ($495 USD), due within 30 days of acceptance; $1500 balance due 60 days prior to session start date.
Please digitally sign and remit this application only if you are serious about attending. Once you are accepted, your $495 nonrefundable deposit within 30 days of acceptance will hold your space in class. If you wish to pay the full amount in advance, you will receive a $250 discount on your tuition ($1745 instead of $1995). This discount is only available if you pay in full within 30 days of acceptance.

By signing below I agree that Main Street Vegan Academy is not responsible for any loss or damage of personal goods which might occur in relation to the course, nor for any personal injury or death which might occur during or in relation to the program.

I certify that I have consulted my physician regarding the physical requirements of the MSV Academy course and regarding any dietary changes I plan to make in relation to the program. I understand that the course is purely informational and being a Main Street Vegan Academy Certified Vegan Lifestyle Coach does not make me a nutritionist or dietitian, and it does not qualify me to treat any illness.

Main Street Academy shall have no responsibility for any actions, programs, promotions, offers, advice, consulting or other activities or services that you may engage in following your participation in the Academy curriculum, and you acknowledge that all such activities and services are at you own risk and initiative.

I also understand that portions of this course and its participants may be recorded and/or photographed; by signing below I allow Main Street Vegan the right to display these images publicly at their discretion.
Your Digital Signature (Please type your full name)*
My digital signature above confirms that: (1) I am a dietary vegan (if you still have some non-vegan clothing, cosmetics, etc., no worries). (2) I intend to pay my tuition or deposit within 30 days. (3) I understand that if I pay a deposit, it is NONREFUNDABLE, but can be applied to one future course. (4) I understand that if I pay a deposit, the balance is due 60 days prior to the start of my course. (5) I understand that if I pay in full and receive a tuition discount, and some emergency keeps me from attending, I will receive a refund in the amount of $1250; $495 will be kept as a deposit which can be applied to one later course. (6) I understand and accept that MSVA days start early and run long. (7) I understand that meals out and field trips via subway and walking are part of the program. By signing here, I attest that I am either (a) able to walk long city blocks, sometimes in inclement weather, climb steep subway stairs, and sometimes ride the subway when no seats are available; OR (b) planning to provide my own transportation at my own expense, to the various restaurant and field trip locations, or skip this part of the program. (An inability to participate in field trips will not keep anyone from certification); (8) I understand and accept that food allergies and medical dietary restrictions will be accommodated to the fullest possible extent, but I affirm by digitally signing here that I have no serious or life-threatening allergy that would make dining in a group setting or going to a variety of restaurants dangerous for me; (9) I understand that Main Street Vegan Academy makes no guarantees to any student that he or she will be able to turn the certification that results from this 5.5-day program into a successful business or side business, although some graduates have done this.
If you have any difficulty in submitting your application, please either: --Scan and email your application to victoria@mainstreetvegan.net --Send your application through the mail: Main Street Vegan Academy, Attn. Victoria Moran, 40 W. 116 St., #A504, New York, NY 10026 --Fax your application to us at 212-360-1253 --Be in touch with us via email (victoria@mainstreetvegan.net) or phone : 212-289-1808

Academy Application Form

Health