Green Gulch Farm Guest Student Application

Arrival Date:

Must be on a Wednsday.

Departure Date:

Must be on a Wednesday.

First Name

Last Name

Phone Number

Identify my gender as (for housing purposes)

What gender pronoun do you go by (i.e. he/him, she/her, they/their or something else?)

Date of Birth

MM/DD/YYYY

Age

Please upload a recent, cropped headshot. There is a free online cropping tool at cropp.me if you need it.

Is it your intention at this time to also apply for the Farm or Garden Apprenticeship, Green Gulch Kitchen Apprenticeship, or Guest Program Apprenticeship?

YesNo

Select which programs you would like to apply to:

Farm or Garden ApprenticeshipGreen Gulch Kitchen ApprenticeshipGuest Program Apprenticeship

Will you be getting your booster dose by the time you arrive? Please give details.

What vaccine(s) did you receive? How many doses of each one have you received and what was the date of your last dose?

Mailing Street

Mailing City

Mailing State/Province

ZIP/Postal Code

First Name

Last Name

Email Address

Phone Number

Alternate Phone

State/Province

ZIP/Postal Code

Physician First Name

Physician Last Name

Physician/Provider Phone

Health Insurance Company Name

Member/Policy Number

Group Number (if one)

Page 2

Please answer the following questions. This information will remain confidential.

Q & A

Brief personal history

Have you practiced at San Francisco Zen Center before?

YesNo

Please give dates and briefly describe (Tassajara/City Center/Green Gulch, summer or guest student/WPA/practice periods). What is your interest and experience with meditation and Buddhist practice now?

Have you ever lived in an intentional or spiritual community?

YesNo

Please describe your experience?

Work experience and skills (please include any form of medical training or experience)

SFZC is committed to promoting diversity, equity, inclusivity and accessibility (DEIA). This could include study groups related to systemic racism, equity for LGBTQI, etc. Are you willing and open to engage in the training, study and practices the temple offers on these topics?

YesNo

Do you have any personal experience studying, responding to, or engaging with issues pertaining to DEIA?

Green Gulch is a vegetarian environment. Do you have any specific dietary needs or restrictions?

Have you ever been convicted of a felony or serious misdemeanor?

YesNo

Please describe (state the nature of the offense(s), when and where convicted, and disposition of the case, and anything else you would like to add)

Housing

Roommate Options

I want to room with other womenI want to room with other menI don’t mind being in a mixed-gender roomI want to be in a mixed-gender room

Factors affecting sleep (Please describe)

Are you interested in continuing in residential practice at Green Gulch

How long to you intend to stay in residence at Green Gulch?

Describe your interests and/or intentions if continuing residential practice at Green Gulch

Agreement

1. Following the schedule of morning and evening meditation, and morning and evening

services of bowing and chanting.

2. Following the work practice schedule.

3. Attending Dharma talks, classes and ceremonies.

4. Attending weekly Guest Student teas.

5. Refraining from drug and alcohol use.

6. Refraining from initiating any new sexual relationships.

7. Following the Green Gulch Residential Guidelines (Shingi).

8. Communicating with the Guest Student Manager in a timely way if having difficulty with

any of these requirements.

I agree to honor these requirements, have read the Green Gulch Residential Guidelines (Shingi) and agree to follow them completely.

Green Gulch Farm Guest Student Application

Page 1

Page 2