Your full name
Your email
Address (Street, City, State, Zip)
Phone number
Gender
Age
Driver’s License Number, Expiration Date, and State of Issuance
When do you want to start your residency?
When do you plan to leave?
Please describe your past experience with meditation, including retreats you have attended, type of meditation, length of time you have been meditating.
Have you attended retreats at the Bhavana Society? If so, please list retreats names and dates
Why would you like to be a long-term guest or resident at Bhavana Society?
Please list work skills you have that could be useful to the Society (for example, office skills, kitchen experience, gardening, construction, writing/editing etc.)
Do you have any physical conditions that will limit your ability to participate fully in the activities of the society or that will require special diets or other accommodations? If yes, please describe the condition and any accommodations that would be required.
If you have any pending legal problems or financial obligations or if you have a history of psychiatric illness, these must be discussed with the Center before you begin any proposed residency.
Please describe in some detail how you have spent the past two or three years (work, school, travel, etc.)
References
Please list three references (not relatives) with their name, phone number, and relationship to you, and how long they have known you . One should be a recent employment supervisor.
Reference 1
Reference 2
Reference 3
Safety Net
Please list the name and phone number of the person who will be your “safety net”— the person who will provide for you if you need to leave Bhavana for any reason. (If it is one of your personal references, just list the name.)
Emergency Information
Person to be notified in the case of emergency (Name, Phone Number, and Relationship)
If above person is unavailable, please notify (Name, Phone Number, and Relationship)
Please list your next of kin if that person is not listed above (Name, Phone Number, and Relationship)
Are you covered by health insurance?
Name of insurance company
Your insurance I.D. number
Group number
Medications you are taking
Allergies to food or medication.
Any underlying medical conditions that we or a doctor may need to know about? If yes, please describe. If no, type no.
Psychological History
Have you ever been diagnosed with a psychological condition (prolonged or serious depression, manic depressive illness, panic attacks or schizophrenia, etc.) or other emotional problems that Bhavana should know about? If yes, please describe the diagnosis, treatment and dates. If no, type no.
Are you currently taking any medication(s)for physical or psychological conditions? If so, please list the medication(s) and the condition(s) being treated. If none, type none.
Are you currently seeing a therapist or counselor?
Are there conditions in your life that might be placing you under stress or that might make living at Bhavana difficult? (e.g. divorce, substance abuse or withdrawal, loss of a loved one, etc.) If yes, please give details. If not, type no.
Have you ever been arrested or convicted of a crime? If yes, please describe. If not, type no.
Are you vaccinated against covid-19?
Please upload a picture of your vaccination card
Do you have any additional information that you would like to convey?
Please upload a recent picture of yourself
Are you a monastic? If so, please write yes or no and fill out the monastic application by following the link provided in the second paragraph on this page
By clicking submit, I acknowledge that I have read and understand the Basic Requirements for Residency and the Terms of Residency. I agree to abide by these terms and conditions, should I be accepted for residency. I understand that failure to do so may result in the termination of my residency. I acknowledge that all the information included in this application is true and complete. I authorize Bhavana Society to contact any of the individuals listed above to support this application and give permission for Bhavana to do a criminal background check, using all information included in this application, with agencies from this state or any state or federal agency, to the extent permitted by state and federal law.
Submit
