ACZC Residential Application
Last Name: *
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First Name: *
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Street address *
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City *
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State *
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Zip Code *
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Phone *
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Email *
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Date of Birth *
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Gender *
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Marital Status *
Name of Spouse/Partner
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Housing Request: *
Emergency Contact: Name *
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Emergency Contact Address *
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Emergency Contact Phone *
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Emergency Contact Email *
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Emergency Contact Relationship *
Vehicle Description *
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Preferred move in date *
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Expected length of occupancy *
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Practice experience: *
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Are you currently a Member of Angel City Zen Center? *
What type of meditation do you currently or have you previously practiced? *
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How long have you or did you do this practice? *
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How frequently do you currently practice? *
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Have you taken vows or been ordained in a Buddhist tradition? *
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Are you formally committed to a teacher? If so, who? *
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Have you practiced regularly with a zen center before? When and where? *
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Are you trained in any Soto Zen service positions? Which? *
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Please describe any other relevant community living experience *
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Please attach a personal statement describing why you would like to live at Angel City Zen Center *
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Please list your education experience *
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Current and recent work experience *
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Any specialized work skills? *
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Hobbies and special interests? *
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Physical & Psychological History: *
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How would you rate your physical health? *
unhealthy
healthy
Do you suffer from major health problems? *
Have you or are you currently seeing a therapist? *
Do you suffer from significant or diagnosed psychological problems? *
Are you seeking treatment for these? *
Do you have any food allergies? Please describe *
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Do you suffer from alcohol or drug addiction? *
Are you currently seeking treatment? Please describe *
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I understand that Angel City Zen Center is a practice center and that preference for residency is based on my commitment to: Buddhism and Zen *
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I understand that Angel City Zen Center is a practice center and that preference for residency is based on my commitment to: Zazen Practice *
Required
I understand that Angel City Zen Center is a practice center and that preference for residency is based on my commitment to: Participation and service in the community *
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Please enter today's date: *
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