[台北全心幼兒園]兒童少年課程(法工)

If No, please fill NO. If Yes, please write down his/her name and relationship.

Have you practiced any other meditation techniques (including other Vipassana techniques) or therapeutic techniques since your last course with S.N. Goenka or his assistant teachers?

Are you teaching any other meditation techniques (including other types of Vipassana), therapies or healing ?

Have you maintained your practice of Vipassana meditation since your last course?

If you are not attending the entire course, please give your arrival date and hour. (Arriving ＆ Leaving time)

If you drive and are willing to give other student a ride, please specify.

Do you have any physical health problems, e.g., diabetes, heart disease, epilepsy, high blood pressure, active communicable diseases such as hepatitis, tuberculosis, typhoid, HIV.+, A.I.D.S., etc.?

Do you have or have you ever had any mental health problem, e.g., significant depression or anxiety, panic attacks, manic depression, schizophrenia etc.?

Are your now taking, or have you taken within the past two years, any prescribed medication?

Are you now taking, or have your taken within the past two years, any drug, e.g., amphetamines, barbiturates, cocaine, heroin, alcohol, or other intoxicants?

前往中心擔任法工提供服務，可以享有每日的共修機會。然而在家人有相應的責任要承擔，因此在中心外提供您的專長與資訊，也是為法服務的一種形式。誠心希望您貢獻您的專長，未來供中心需專業諮詢時洽談。

如果已填寫過，請填「已填寫」即可，謝謝。

中心的各項日常運作、建設均需要各式人才提供您的專業建議。如您能運用空暇時間或是您任職公司所屬服務，使中心可以建設的更好與並提供更佳的服務環境。

日期格式如2014/01/01