Member / Visitor / Volunteer Application

Email to: positivelydanschultz@gmail.com or physically mail to: P.O. Box 246 Gasquet, California 95543

Interesed in :
Visit (one day)
Volunteer (minimum two weeks)
Membership

Full name ________________________________________________

DOB ____________________

Permanent address ________________________________________

________________________________________________________

Children('s) names and ages (visiting with you) ____________________

________________________________________________________
(other adult members of family apply separately)

Home phone number ______________________________

Cell Phone number ________________________________

Email address(es) ________________________________

_______________________________________________

Web address(es) _________________________________

_______________________________________________

Desired dates of visit/stay/internship _______________________________

List three references (name, address, phone numbers)

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Work experience

Company _________________________________________________

Position ___________________________________________

Duties ____________________________________________

Duration __________________________

Reason for leaving __________________________________________

_________________ _______________________________________

Company _________________________________________________

Position ___________________________________________

Duties ____________________________________________

Duration __________________________

Reason for leaving __________________________________________

_________________ _______________________________________

 

Essay section
Our objective is to know each potential (and Provisional Member) member as fully as possible. Please answer in great honesty, transparency and thoroughness.

1) Describe the skills, talents and aptitudes that would make you a valuable and contributing intern/member of our community.

2) Have you lived in community previously? If so, what was your experience like?

3) How do you handle disagreements or conflicts?

4) What are your personally held beliefs about health?

5) Do you have any health challenges? Please elaborate.

6) What spiritual beliefs do you possess? How do you feel about other, differing, spiritual beliefs?

7) What are your personally held beliefs about nature, ecology, and environmental practices?

8) What other of your personally held ideas or beliefs should the community, in order to know you well, seek to understand and/or accept?

9) Maitreya Mountain Village is a smoke-free, drug-free area. Do you have a drug, alcohol or tobacco history or challenge? Are you willing to agree and adhere to our substance policy?

10) Do you have any legal challenges or prior convictions? Please explain.