Adult student learning

Student Intake Application

This form begins an application for structured spiritual learning. It is not a request for services, a ritual consultation, an initiation application, or a guarantee of acceptance.

Contact and study plan Legal name Preferred name Email Phone number What would you like to study? How many hours per week can you usually give to reading, practice, discussion, and review?

Choose up to three goals that best describe why you are applying.

Background and learning context Cultural connection or exposure (optional) Relevant spiritual or religious learning (optional) Relevant study experience (optional) Martial-arts or movement background (optional) Participation or learning considerations (optional)

Private health and safety screening

This limited screening helps staff decide whether follow-up or additional support is needed. It is not medical advice, diagnosis, treatment, or an automatic decision about acceptance. A “yes” or “prefer to discuss” response does not automatically exclude you; it simply lets us arrange an appropriate confidential follow-up before particular activities. Answers are restricted to authorized staff review and are separate from the future power-medicine intake.

Have you ever had epilepsy or seizures? Do you currently use prescription medication that may affect attention, mood, perception, sleep, or participation? Have you experienced psychosis, a schizophrenia-spectrum condition, or psychiatric hospitalization? Is there another physical or psychological safety consideration staff should know before placing you in study activities? Optional details for authorized staff I have answered the safety questions accurately to the best of my knowledge. I understand that I must tell staff if relevant information changes, that this screening is not medical care, and that I should seek qualified medical support when needed.

I confirm I am at least 18 years old.