If you have any questions about filling out this application please contact our retreat coordinator, Ngawang Khandro, by email at retreats@white-conch.org or by phone at 715-743-6743.

Your Name

Gender

Your Email

Home Address

Telephone Number

Occupation

Date of Birth

Proposed Arrival Date

Proposed Departure Date

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.

During your time here at Lotus Lake, you will be able to practice meditation in the Tibetan Buddhist style and the forms of our lineage. Are you open to this and what (if applicable) can you see as the implications for your current practice and/or relationship(s) with (an)other teacher(s)?

Please describe any experience you have had living in community.

How did you find out about Lotus Lake and what causes you to choose this as a place to live and practice?

Please describe your experience practicing in the context of a daily schedule?

What kind of personal time do you require?

What do you hope to gain or accomplish during your time at Lotus Lake?

What do you hope to contribute while you are here?

What leads you to apply for an internship at this particular time in your life?

What is your current financial situation?

Please describe your educational background and work history.

Please describe any experience you have had with housekeeping, cooking, gardening, facility maintenance and carpentry.

Do you have a regular physical/exercise program? If so, please describe it.

Do you have any physical conditions which would prevent you from doing physical tasks such as gardening, house cleaning or painting? If so, please describe them for us.

Are you currently under a doctor’s care? If so, please describe the situation.

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? If yes, would it be possible for us to get the contact information for a reference?

Are you taking any prescription medication? If so, which one(s) and for what reason(s)?

Please comment on your strengths or challenges as they relate to each of the following qualities, by providing examples of how they manifest in your life.

  • Dependability
  • Humor

  • Consistency
  • Honesty
  • Emotional Stability
  • Compassion/Kindness
  • Teamwork
  • Openness

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.

Which piece of government-issued identification can you show upon arrival? For citizens of another country: On which visa program are planning to enter/stay in the US?

Any further comments?

White Conch