2024 Fall Intensive Application

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Full Name *

Cell Phone Number *

Email Address *

City, State/Province, Zip Code *

Age *

What are your racialized identities? *

What are your gender based identities? Include your pronouns and whether you identify as cis-gendered, trans-gendered or non-binary. *

What is your sexual orientation? *

Do you identify as disabled or do you live with a disability? *

Previous/current occupations? *

Have you attended three or more 5+ day residential retreats in the past five years? This is a minimum for the Fall Intensive. *

Yes

Maybe

What was the last 5-day (or longer) residential retreat you attended? *

What was the last longest residential retreat you attended? *

What are your top three motivations for taking this current Intensive? *

What are your current daily or weekly spiritual/meditation practices? *

Can you commit to practicing at least 25 minutes of sitting meditation each day during the Intensive? *

Yes

Maybe

Have you experienced prolonged mental distress or mental illness in the past 3 years? If yes, please briefly describe. *

What are the areas in your current life where you find your greater challenges to be mindfully present or kind to yourself and others? *

Indicate any reasons you might miss a class or a daylong (travel or obligations): *

Please indicate the upper amount you can afford for the program. If you cannot offer the full $950, describe your financial circumstances. *

Signature (by typing your name here you are agreeing to follow the full program): *

Once you have fill out this form please email <tempel108 [at] gmail.com> a digital current picture of yourself and say you have filled out this form.

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