The training being applied for is: Tick here Vanaprastha Sadhana Satra From 27 th July, 2018 to 20 th August, 2018 Vanaprastha Sadhana Satra From 26 th August, 2018 to 25 th September, 2018 Have you previously applied for this type of training? Y / N If yes, give details:..... I enclose DD amount Rs. 2000/- payable to Sannyasa Peeth, Munger, towards the application fees, which I understand is non-refundable and non-transferable. COVER PAGE FOR OFFICE USE Application form received on:... By: post / hand / fax / other along with: Photos Photocopies: Passport Pan card / Aadhaar card Curriculum Vitae (CV) Medical report List of current medication/s Declaration by applicant Advance Rs. 2000/- received: Yes Receipt no.:.. Date:....... By Demand Draft no.:... Dated:... Bank:... Other:.... Admission letter sent on:..... By: post / hand / other...... Date of arrival:......... Date of admission:......... Date of departure:... Reason for departure:... Remarks:......... Application form received by... 2018 SPvp Appform Page 1
The applicant should fill in this application form in CAPITAL LETTERS and send it to Sannyasa Peeth by registered letter or speed post. All personal information disclosed here will be treated confidentially. The date for receiving applications closes 30 days prior to commencement. Late and incomplete applications will not be accepted. Kindly enclose your curriculum vitae (CV) with this application. All vanaprastha sadhana satra participants are expected to abide by the rules of the ashram, maintain the discipline and also participate in the daily activities and seva. Admission policy is selective and a personal introduction is preferred when accepting applications. Sannyasa Peeth reserves the right of admission. VANAPRASTHA SADHANA SATRA PERSONAL INFORMATION 1. Full name (surname first):... 2. Spiritual name (if any):... Given by:... 3. Date of birth: Day Month Year Age in years 4. Sex: Male Female 5. Marital status Married Unmarried 6. Permanent address:... 7. Phone number: Home:... Mobile:... Work:... 8. Present address (if different):... PERSONAL IDENTIFICATION 9. Your email ID:... Website:... Facebook ID:... Twitter ID:... 10. Present nationality:... Nationality at birth:... 11. Birthplace City:... State:... Country:... 12. Passport no.:... Issued by:... valid until:... 13. Native language:... 14. Spoken languages and level of proficiency:... 2018 SPvp Appform Page 2
16. Pan card:... Aadhaar card:... 17. Any other ID, detail:... FAMILY DETAILS Name Age Profession 18. Husband / wife......... Names & ages of children (if any).................................... 19. In case of emergency, notify my:... Phone:... Email:... 20. Professional qualifications: EMPLOYMENT/PROFESSIONAL DETAILS 21. Present or previous occupation/profession: YOGA & ASHRAM EXPERIENCE 22. Yogic training, if any; write details on a SEPARATE SHEET including course name, place, duration, syllabus, teacher/s, a copy of certificate attained, in addition to your curriculum vitae (CV). 23. Yoga Teaching as: Yoga Teacher Yoga Consultant Yoga Therapist a) Give details:... 2018 SPvp Appform Page 3
b) Place of teaching (home, ashram, hospital, school, etc.):.... c) Duration:... d) Location (city, town, village):... e) Country:... 24. List the major books on yoga, sannyasa and spiritual life you have read:... 25. Have you written any papers, articles and/or books on yoga or related topics? Y / N If yes, provide details:... 26. Propagation (conducted / organised / participated) please list (give details on a separate sheet if required): a) Yoga camps:... b) Lectures/seminars on yoga:... c) Sadhana programs:... 27. What is the aim of your yoga practice (physical health / mental wellbeing / concentration / emotional wellbeing / psychic / spiritual / other)?... 28. List any ashram experience below: Year Ashram name, location Duration of stay Activity / involvement.................................... 2018 SPvp Appform Page 4
29. Have you stayed at Munger ashram before? Y / N If yes, list periods of ashram experience: Year... Duration... Purpose... Year... Duration... Purpose... Year... Duration... Purpose... Year... Duration... Purpose... SANNYASA LIFE EXPERIENCE 30. Do you have any experience of sannyasa life? Y / N If yes, please give details below: Name of institution / ashram:......... Duration of stay:........ 31. Have you received initiation(s)? Y / N If yes, give details: Year /month Place Spiritual name From whom Mantra............ Jignasu............ Karma............ Poorna............ MEDICAL HISTORY & LIFESTYLE 32. Present/past medical history (tick if applicable): Arthritis Sciatica Lower back problems Asthma Thyroid disease Obesity Cardiac problems Cancer Parkinsons Dementia Alzheimers Kidney problem 33. Do you have (HBP) Y / N If yes, answer the following: My HBP is: Under control Not under control 2018 SPvp Appform Page 5
What medical treatment are you using?......... Have you had any complications like stroke, angina, kidney disorders, eye problems etc? If yes, give details:......... 34. Do you have Diabetes Y / N If yes, answer the following: My diabetes is: Under control Not under control What medical treatment are you using?......... Have you had any complications like stroke, angina, eye problems etc? If yes, give details:......... 35. Are you taking any medications at present? Y / N If yes, give name and for what condition: a)... b)... c)... Attach medical report/s for the above-mentioned or any other CURRENT health problems 38. Have you had any mental health problems, ie. anxiety, panic attacks, depression, etc.? Y / N If yes, give details of symptoms, duration, treatment and present condition:...... 36. Name and mobile phone number of your current medical practitioner:... 2018 SPvp Appform Page 6
37. List any habits, such as alcohol, drugs, smoking, tea, coffee, etc.:... 38. Are you a vegetarian? Y / N 39. Do you have any dietary restrictions? Y / N If yes, give details:..... 40. Can you manage with simple, vegetarian food which is prepared in the ashram for everyone, as personal cooking is not permitted, and there is no provision for individual catering? SOCIAL ACTIVITIES Y / N 41. While you are resident at the ashram, are you willing to participate in all activities wholeheartedly? Y / N 42. List the skills you have to assist with ashram activities (driving / gardening / electrical / musical / IT/computer, etc.):..... 43. List your main hobbies:... 44. Do you prefer solitude or the company of others?... 45. Are you active in public life in any capacity? Y / N If yes, give details:... 46. Are you or any member of your family related to any political or religious organizations? Y / N If yes, give details:... 47. Have you ever been prosecuted for any criminal offence? Y / N If yes, give full details of offence committed and sentence undergone:... 2018 SPvp Appform Page 7
48. My reason and intention for seeking admission to the Vanaprastha Sadhana Satra is:..... DECLARATION BY THE APPLICANT 1. I, the undersigned, declare that the information given in this application is true, complete and accurate to the best of my knowledge. 2. I understand that if during the interview and admission procedure it is found that the information given in this form is incorrect, I will not be eligible. 3. I further declare that there are no criminal or civil litigation or charges against me. 4. I am solely responsible for my health, welfare and medications while I undergo sadhana satra in the campus. In case of any illness, I will discontinue and leave the campus for proper medical care. 5. In case of any emergency or unforeseen medical situation or treatment, all expenses will be borne by me and I will not hold Sannyasa Peeth liable in any regard. 6. I understand that local medical facilities in Munger are very limited, and there is no provision for homeopath, ayurveda or any other alternate therapy. In case of illness I will follow the local medical doctor s advice and prescription, or else discontinue the training. 7. I will contribute to and participate in all the activities of the ashram wholeheartedly in the spirit of nishkama seva (service without personal motive). 8. I understand that Sannyasa Peeth is an ashram, and all personal chores along with the chores and work of the ashram are performed by each resident to the best of their ability, without exception. 9. I understand that accommodation facilities in the ashram are limited, and it is not possible to accommodate husbands and wives together. I can adjust to separate accommodation. 10. During my stay I will lead a life of sanyam (restraint in thought, word and deed), sahayoga (willing cooperation) and shanti (harmony & peace) and follow all the rules of Sannyasa Peeth. Signed... Date... Checklist of documents to enclose with this application: 2 current passport-size photos Photocopy Aadhaar card/pan card Medical details Copy of CV Demand draft for Rs. 2000/- 2018 SPvp Appform Page 8