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Application Information
Application status:
Application complete:	Yes
Archived?	Yes
Quality:
Scholarship status:
Submitted on:
Application year *:

Retreat Information
Type:
Center:
From:
To:
Duration:	months
$ Requested:

Correspondence

Add a Correspondence

Personal Info

First name:
Last name:
Other name(s) For Dharma names and/or potentially for middle names.:
Date of birth:
Country of birth:
Age at start of retreat:
Nationality:
Gender:
Ordained:
Previous 3yr retreat?	Yes

Address

Street:
City:
State or Province:
Postal Code:
Country:

Contact

Email:
Retreat email:
Telephone:
Other contact information:

Background

Family story
Relationship(s)
Professional activity

Retreat Center or Hermitage Info

Retreat Center Name:
Street:
City:
State or Province:
Postal Code:
Country:
Retreat master:
Retreat administrator:
Email:
Retreatant liason person:
Email:
Retreat dates notes:
Solitary hermitage description:

Dharma Practice Experience

When did you start to study Buddhism and with whom? Please describe:

When did you take refuge, and with whom?

Have you taken formal Buddhist vows (lay precepts, monastic vows, bodhisattva vow)?

Yes

If so, please describe them:

Main teachers:

Have you completed the (full 100,000 each of the) Preliminary Practices (Ngöndro)?

Yes

	Ngondro name	Start date	End date
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Ngondro notes:

Have you partially completed the Preliminary Practices (Ngöndro)?

If yes, when did you begin?
How much have you completed? Other notes?

Have you completed previous group or individual retreats of one month or longer?

Yes

Please list and describe:

Language Proficiencies

What other languages do you know and to what level of competence?
Have you studied the Tibetan language?	Yes
What is your level of comprehension of spoken Tibetan?
What is your level of comprehension of written Tibetan?
To what extent is the Tibetan language a requirement for the retreat you intend to enter?
What parts of the retreat will function in Tibetan: for instance, instruction, group rituals, individual practice? Please describe:
Type the languages you know:	Select the proficiency level for each language:
1.
2.
3.
4.
5.

CV Information

Education
List of diplomas and accreditation
Professional work activity: last 3 professional engagements
CV Notes

Studies and Community Experience

Have you engaged in advanced Buddhist studies programs?	Yes
If so, please give details:
Have you offered your services to your lama or Dharma community?	Yes
In what capacity and for what length of time?
Other community work?

Funding

Start of requested funding:
End of requested funding:
Estimated individual cost for the retreat:
Notes on cost of retreat:
Other sources of financial support (personal savings, family support, sponsors): Please specify.
Financial need:

Disbursements

* Use numbers only.

	Total	Monthly	# of Months
Currency:

Conversion rates:
1 USD ($) =
0.93321 EUR (€) (change)
0.82843 GBP (£) (change)
You can check rates at the following links: XE | Travelex | Convert My Money | Yahoo | The Money Converter

Letter of Motivation

Please describe in your own words your aspirations and reasons for wanting to do this retreat and why we should consider your application. (~ 500 words)

Quality:
Notes on letter of motivation:

Notes

Intelligence Quotient:
La Maladie Quotient:
Personality:
Post Interview Profile:

Document Checklist

Three-year Retreat Documents

X

Acceptance Letter from Retreat Master

Name of the lama writing the letter
Email
Phone
Uploaded File		Upload File

X

Description of Retreat Center and Retreat Program

Upload File

X

Letter from Retreat Administrator outlining budget and costs

Name of the manager writing the letter
Email
Phone
Uploaded File		Upload File

X

Retreat eligibility requirements and extent to which you satisfy these

Upload File

Solitary Retreat Documents
X	Description of hermitage and support system	Upload File
X	Description of retreat program and schedules	Upload File
X	Retreat budget	Upload File

All Applicants
X	A standard curriculum vitae	Upload File
X	A Dharma curriculum vitae	Upload File
X	A recent head and shoulders photo	Upload File
X	A clear description of your financial situation	Upload File

Recommendation #1
	A letter of recommendation from your current lama or meditation instructor
File:		Upload File
Name:
Name (old):
Email:
Phone:
Relationship:
Rating:

Recommendation #2
	A letter of recommendation from your current lama or meditation instructor
File:		Upload File
Name:
Name (old):
Email:
Phone:
Relationship:
Rating:

Full list of uploaded documents

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