Resident Application Form - Providence Zen Center

Name*

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Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Gender*

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Female
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Occupation*

Date of Birth*

Proposed Date of Arrival*

Proposed Date of Departure (if known)

Please tell us about the meditation practices and spiritual traditions in which you are or have been involved. Describe your current spiritual practice.*

Describe your experience in a teacher/student relationship. Please tell us with whom you have studied and when.*

Please read and review PZC Resident Handbook. Do you have any questions or concerns relating to your ability to practice with us?*

Please describe any experience you have had living in community.*

Why do you want to live at a Zen Center? Why Providence Zen center at this time?*

Do you have experience practicing in the context of a daily schedule? If yes, please describe you experiences.*

What is your current employment/financial situation?*

Please describe your educational background and work history, include resume if possible.*

Please describe any community skills you have had with housekeeping, cooking, gardening, facility maintenance, IT, and carpentry.*

Do you have any medical conditions, which would prevent you from participating in physical activities such as gardening, snow shoveling, house cleaning or painting? If so, please describe.*

Have you spent any time in an institution (prison, mental health, substance abuse, etc.) in the last five years? If so, when and why?*

Do you suffer, or have ever suffered, from any psychological or emotional problems, such as depression, addiction, bi-polar disorder, etc.? If yes, please describe it for us.*

Are you currently working, or have ever worked, with a psychiatrist or therapist? Please explain briefly.*

Are you taking any prescription medication? Please list.*

Please list two work/personal references, other than a family member, along with contact information (please include email addresses).*

Whom should we contact in case of emergency? Please give contact information.*

Are you a currently a member of the Kwan Um School of Zen?*

Do you have a State/Federal ID?*

This will be required upon arrival

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