Green Gulch by coltonvelencia


									Green Gulch Student Application                                                                       Office Use Only
Green Gulch Farm                                                                                     Rcd: ____________
1601 Shoreline Highway
Muir Beach, CA 94965                                                                                 Acd: ____________
Guest Student Manager: (415) 354-0425 Fax: (415) 383-3128
Farm & Garden Program: (415) 354-0432 Fax: (415) 383-3128              Guest Student Stay
Work Practice Program: (415) 354-0422 Fax: (415) 383-3128                 Beg: ___________
                                                                                                     End: ____________

  [Picture goes here]

  Program(s) you are applying for: (check all that apply)

  __ Guest Student Program
  __ Farm Apprentice (April – October stay)
  __ Garden Apprentice (April – October stay)
  __ Work Practice Apprentice (Six month stay, with 2 weeks as a Guest Student a prerequisite)

 Today’s Date:


 Street Address (including zip)   ________


 Phone                                             Cell Phone

 Email address

 Gender                                            Age

 Dates you are requesting for Guest Student Stay (please start on a Saturday if this is your first time):
        Arrive:                          Depart:

 Pg. 1 Student App Rev 8/08
Who should we contact in case of emergency?

Name                                                         Phone

Email                                                        Relationship:

Physician Name                                               Phone

Medical Insurance Co.                         Subscriber #                   Group#

Date of your last tetanus shot:

Any other pertinent information that would be needed in a medical emergency (allergies, asthma, conditions,
prescriptions, medications, etc.)

Regarding possible past or present mental health conditions, drug use, or use of medications – do you have any
needs or requests you would like us to be aware of?

2   Student applic – Rev 8/08
ZEN Related Practice History (none required)
Please take a few minutes to tell us about your background and activities that may be related to Zen practice, so
we can start to get acquainted with you.

Help us find your file, if you have practiced with us before!
Have you already participated in any of the Guest Student, Summer or Apprenticeship Programs at any of the San
Francisco Zen Center locations ? If so, for how long ____________
Have you been in residence at any Zen Center locations before? If so, when and where did you reside?

Tassajara____________ City Center______________GGF_________________
          (dates)                        (dates)              (dates)

Do you have any Practice Period credits at this time? _________ Please explain:

Have you participated or resided in any other Buddhist practice places? Do you have a meditation practice? Have
you been interessted in meditation and done various explorations? Tell us about your experience, “No previous
experience” is an acceptable response.

3   Student applic – Rev 8/08
Housing, Food, and Work
Housing is dormitory style. Do you have any sleep conditions that might make it difficult to share a room with

Do you have any physical conditions that might limit your meditation or work practice? Please explain.

Meals are vegetarian and a vegan alternative is generally offered. Do you have any food allergies or other food
concerns that would require special attention by the kitchen?

Do you smoke? If so, please be aware that there are very limited smoking facilities around Green Gulch Farm.

If you have had substance abuse issues, have you participated in a treatment program? How long have you been
in recovery? What will you need in terms of support at Green Gulch? Weekly 12-Step meetings are offered at
Green Gulch.

How did you hear about the program(s) for which you are applying?

Please list any special skills you have.

4   Student applic – Rev 8/08
5   Student applic – Rev 8/08

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