Mindfulness Center in the Plum Village Tradition
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Mindful Living and Service Program Application
MLS Program June 1st – Aug 1st 2019
Morning Sun Immersion Opportunity Application 2020
Your Full Name
Mental and Physical Health
Please share with us any known physical health issues, medications, mental illness, previous experiences of mental illness, allergies to medications or products, that we should know about. Mental illness can range from depression, anxiety, schizophrenia, insomnia, eating disorders, and so on. Please be as specific as possible so that we can learn how to support you.
I have current health insurance
I do not have health insurance
Other Notes, Messages, Things We Should Be Aware Of
Emergency Contact Full Name
Emergency Contact Email
Emergency Contact Phone Number
Please provide a reference. This could be an employer, teacher/mentor, professional acquaintance, sangha friend/facilitator, etc.
Reference Full Name
Reference Relationship to You
Meditation and Mindfulness Experience
Please briefly summarize your experience with meditation, mindfulness, and the teachings of Thich Nhat Hanh.
Skills and Interests
Please write a short list of personal passions, skills and work experience.
Statement on Intentions
Please write a short statement that includes: why you wish to participate in program, what you hope to gain from the program, and how you see that you can contribute.
Pressing the Submit Button will submit your application to MorningSun. Looking forward to seeing you soon!
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