Providence Zen Center Resident Application Form
Please complete application as completely as possible. If a question does not apply to you, please enter NA (Not applicable)
Email address *
Full Name *
Gender *
Address *
E-Mail Address *
Telephone *
Occupation *
Date of Birth *
Proposed Date of Arrival *
Proposed Date of Departure (if known)
1. Please tell us about the meditation practices and spiritual traditions in which you are or have been involved. Describe your current spiritual practice. *
2. Describe your experience in a teacher/student relationship. Please tell us with whom you have studied and when. *
3. Please read and review PZC Resident Handbook. Do you have any questions or concerns relating to your ability to practice with us? *
4. Please describe any experience you have had living in community. *
5. Why do you want to live at a Zen Center? Why Providence Zen center at this time? *
6. Do you have experience practicing in the context of a daily schedule? If yes, please describe you experiences. *
7. What is your current employment/financial situation? *
8. Please describe your educational background and work history, include resume if possible. *
9. Please describe any community skills you have had with housekeeping, cooking, gardening, facility maintenance, IT, and carpentry. *
10. Do you have any medical conditions, which would prevent you from participating in physical activities such as gardening, snow shoveling, house cleaning or painting? If so, please describe. *
11. Have you spent any time in an institution (prison, mental health, substance abuse, etc.) in the last five years? If so, when and why? *
12. Do you suffer, or have ever suffered, from any psychological or emotional problems, such as depression, addiction, bi-polar disorder, etc.? If yes, please describe it for us. *
13. Are you currently working, or have ever worked, with a psychiatrist or therapist? Please explain briefly. *
14. Are you taking any prescription medication? Please list. *
15. Please list two work/personal references, other than a family member, along with contact information (please include email addresses). *
16. Whom should we contact in case of emergency? Please give contact information. *
17. Are you a currently a member of the Kwan Um School of Zen? *
State/Federal ID required upon arrival at PZC
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