Touching the Earth
2018 Dhamma Awareness Training Application

Please complete all fields below and email to , or complete the application online.

I am requesting each applicant to answer the following questions about their personal, medical, psychological and meditation history so that we may more skillfully guide your practice as an individual and as a member of the group. This information is strictly for confidential use of the teachers only and this information will be deleted at the end of this Training. (Some of the information may be requested again on the Registration form as it may relate to retreat participation.) Please be as complete as possible and use additional space as needed. Thank you for offering this information. ~Steve

Full Name: /
Age:

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Address:

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Apartment/Unit #

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ZIP Code

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Occupation:
Gender: /
Self-identified Sexual Orientation:
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Primary Language:
Self-identified different physical ability:

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If you are between the ages of 18–35, will you require a Young Adult subsidy to enable you to attend?

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Do you anticipate needing scholarship assistance to be able to participate in this Training?

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Do you have a domestic partner or spouse that is also applying for this Training?

If so, what is their name? Would you be interested in rooming togetherand observing the 5 Retreatant Precepts while on retreat?

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Do you have a medical or physical condition for which you may need a single room? If yes, please provide further details.

Please be as complete as possible and use additional space as needed.

Please give a brief history of your spiritual or meditative history identifying major teachers, traditions, practices with dates and length of time with each?

Please list dates and length of any previous practice retreats or study with Steve or Kamala Masters.

Please list dates, teachers, type of practice with other mindfulness meditation teachers.

Have you completed any other dhammaor mindfulness trainings, eg. CDL, DPP, APP, MBSR, etc.

If so, please itemize by type and with dates and teachers.

What Dhamma study courses have you taken?Eg. BCBS, SCBS, on-line courses, etc.

Do you currently have a daily or weekly spiritual practice(s)? Please describe.

Please describe the benefit you have received from study of the Dhamma and practice of mindfulness. What motivates you to apply for this Training? What do you expect to get from it?

THIS INFORMATION IS IMPORTANT TO FILL OUT.

In the event of emergency on retreat, whom should we notify?

Contact Name:
Relationship: /
Phone:
Are you currently seeing a therapist or counsellor? Yes: /
No:
If yes, does your therapist approve your participation on silent retreats? Yes: /
No:

In the event of a psychological emergency, do we have your permission to contact your therapist?

Yes: /
No:
Therapist’s Name:
Phone W: /
H:

Do you have a history of physical illness or current physical limitations that might be aggravated by or interfere with climbing stairs, sitting and/or walking?

Please list physical or psychological conditions you are currently taking medications for:

1) condition/symptoms, 2) medication, 3) dosage, 4) length of time on this medication?

Have you ever been hospitalized for a psychological condition?

If so, please describe with 1) dates, 2) symptoms, 3) diagnosis and treatment.

Do you have a known history of physical, psychological/emotional or sexual abuse?

If so, and you are selected to participate in the Training, would you be willing to speak to Steve or Kamala about it?

Have you ever attempted to suicide?

If so, when or at what age?

At this time, what matters most to you in your life and why?

Are there present conditions or circumstances in your life which might be placing you under additional stress or which might make meditation difficult for you at this time (e.g. fasting, substance abuse or withdrawal, loss of loved one, job, significant transition, etc.)?

What are the most challenging (physical, mental, emotional, political, financial, relational, philosophical, and/or spiritual) conditions you are living with?

In your career work, did you or do you teach, coach or suggest that your students, clients, patients, parishioners, etc. use or learn to use mindfulness for their own personal benefit? If so, please describe what you teach, to whom and for how long a period of time, number of classes, etc.

Do you volunteer or offer personal skills service to anysocial, civic, political, Dharma, spiritual, etc. organizations or groups? If so, in what capacity and how many hours/week or hours/month?

Can you commit to 1+ hour/day of Dhamma study/practice for the 10-month duration of this Training?

If your application is not drawn for the 2018 Training are you interested in:

  • participating in an online-based (Modules #1-3) version of the Dhamma Awareness Training?
  • hearing about comparable programs offered in the future?

Is there any additional information or comments you would like to share with the teacher(s)?

We are looking for applicants that can make a commitment to participate fully in this Training. It is important that you have a realistic appraisal of what you are signing up for, just as it is important to us that we have a realistic appraisal of your willingness and ability to participate fully in this Training.

Your signature here indicates to us that you can schedule and are willingto make the commitment to attend the three retreats and fully engage in all modules of this Training in light of your other professional, personal, domestic, civic, etc. responsibilities?

Signature: /
Date:

THANK YOU FOR COMPLETING THIS APPLICATION.

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