Going Beyond Course - Application for Work with Teacher

Apply for work with a teacher here unless you are taking the course as Continuing Education.

We will forward this application to a teacher of your choice. Current available teachers

Name of teacher: #1
Name of teacher: #2

Name

Street Address or P. O. Box

(Apartment Number)

City

State

Zip

Country

E-mail Address

Web Site URL (if any)

Telephone # (include area code)

Place of Employment

Occupation

Birthday

What is your previous experience with meditation or body work? Describe below.

Do you have a physical or psychological health problem? If so, please explain below:

Are you taking any medications?:

I understand that meditation teachers are not therapists and that it is my process that guides our work. I am free to accept or reject any suggestions the teacher makes. I will be open to the process and trust my own heart to know what is true. I will periodicallly review my purpose in working with this teacher to determine if it is time to move on or redefine our work.

Name
Street Address or P. O. Box
(Apartment Number)
City
State
Zip
Country
E-mail Address
Web Site URL (if any)
Telephone # (include area code)
Place of Employment
Occupation
Birthday

I understand that meditation teachers are not therapists and that it is my process that guides our work. I am free to accept or reject any suggestions the teacher makes. I will be open to the process and trust my own heart to know what is true. I will periodicallly review my purpose in working with this teacher to determine if it is time to move on or redefine our work.