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)
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Name
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Gender
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Address
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E-Mail Address
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Telephone
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Occupation
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Date of Birth
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Proposed Date of Arrival
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Proposed Date of Departure (if known)
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1. Please tell us about the meditation practices and spiritual traditions in which you are or have been involved. Describe your current spiritual practice.
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2. Describe your experience in a teacher/student relationship. Please tell us with whom you have studied and when.
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3. Please read and review PZC Resident Handbook. Do you have any questions or concerns relating to your ability to practice with us?
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4. Please describe any experience you have had living in community.
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5. Why do you want to live at a Zen Center? Why Providence Zen center at this time?
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6. Do you have experience practicing in the context of a daily schedule? If yes, please describe you experiences.
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7. What is your current employment/financial situation?
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8. Please describe your educational background and work history, include resume if possible.
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9. Please describe any community skills you have had with housekeeping, cooking, gardening, facility maintenance, IT, and carpentry.
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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.
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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?
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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.
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13. Are you currently working, or have ever worked, with a psychiatrist or therapist? Please explain briefly.
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14. Are you taking any prescription medication? Please list.
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15. Please list two work/personal references, other than a family member, along with contact information (please include email addresses).
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16. Whom should we contact in case of emergency? Please give contact information.
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State/Federal ID required upon arrival at PZC
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