Nirvana Friends Program
Please answer the questions to the best of your abilities. Provide a Phone number / email address, so that we can follow up with you. There are limited spots available for this program and will be considered based on availability.
Legal Name *
Sannyas Name (if applicable)
Address, Contact Information *
Please provide your current contact information, email and phone.
Do you have any medical concerns, allergies, take any medicine or drugs? *
Do you or anyone in your family have a history of psychological illness or treatment? *
What is your work and financial situation? *
What inner area of your life (emotional, psychological) do you want to change ? *
What outer area (work, relationships, health) do you want to change? *
Have you tried any therapies, growth trainings, etc.? Please list. *
What do you like best about yourself? *
What do you like least about yourself? *
What gives you the most joy? *
What gives you the most pain? *
What gifts or talents would you like to share with our community? In what way? What are your goals for staying here? How long would you like to stay? *
Would you like to experience a silent meditation retreat during your stay? *
What is the best way to contact you? *
Elaborate on which activities you would like to do during your stay: (Shopping, Clean Common Areas, Cook, Wash DishesLaundry, Help in the Orchards and Gardens, Others....) *
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