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2017 Fall Intensive Application
(you might have to scroll down both within the form and outside of the form to get to the very end)
Full Name *
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
Home Mailing Address *
Your answer
Date of Birth *
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DD
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YYYY
Occupation *
Your answer
What was the last 7-day (or longer) residential retreat meditation you attended? *
Your answer
What are your top three motivations for taking the Intensive? *
Your answer
What experience do you have with mindfulness and the brahma viharas? *
Your answer
What is your current daily or weekly spiritual/meditation practices? *
Your answer
Have you recently experienced prolonged mental distress or mental illness? *
Your answer
What are the areas in your current life where you find your greatest challenges to be mindfully present or kind to yourself or others? *
Your answer
Indicate any reasons you might miss a class or a daylong (travel or obligations): *
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Please indicate the upper amount you can afford for the program. If you cannot offer the full $950, describe your financial circumstances. *
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Signature (by typing your name here you are agreeing to follow the full program).: *
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Please email tempeldpp@gmail.com with a digital current picture of yourself and say you have filled out this form
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