Retreat Participant Questionnaire

The purpose of this form is to introduce you to the teachers. No one sees it but the teachers, and it is shredded after the retreat. The questions are just guidelines for you to communicate what you want the teachers to know about you, about how things are going in your life, and about your practice.

1. Your Name*
First Last
2. Pronouns
3. Please describe your meditation retreat experience*
4. Please describe briefly your non-retreat (ie. home) meditation practice experience*
5. Please describe any other spiritual practice experience.*
6. Have there been any significant life events recently (ie death in family, illness, loss of work, etc.)? Please describe briefly.*
7. Do you have a history of particular difficult mental states? Please describe briefly.*
8. What will be your situation at home during this online retreat? (Are you alone, or with family? Will you need to attend to other responsibilities during retreat?)*
9. Emergency contact person and contact information*

Retreat Participant Questionnaire

Retreat Participant Questionnaire

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