Tara Dhatu Educational Program Application Profile Form

Please copy these questions with your personal answers into an email

and send it, together with a photo (JPG) to:

 info@taradhatu.org

Legal Name: (First, Middle, Last)

Spiritual Name/s (Please explain: from what tradition; who gave you the name; what does it mean.)

What would you like us to call you?

Date of Birth

Place of Birth

Home Address

(Street)

(City)

(State)

(zip)

Mailing Address (if different)

(Street)

(City)

(State)

(zip)

Home Phone:

Cell Phone:

Work Phone: (time and days at work)

Email address:

How often do you check your email?

Your personal or Business Oriented Web Site/s:

Education (High School/College/Degrees/Technical Training)

Are you currently In school or training?­­­­­­­­­­­­­­­­­­

Current Employment:

Ethnic Background:

Are you married or in partnership?

Partner’s Name:

Do you have children? (please list the name, gender, and age of each

Spiritual Experience/background.

 What religion were you born into?

What have been the main paths that you have been involved with? (Teachers/lineage)

Do you have any background in Buddhism? (Please discuss teacher/s and lineage.)

Are you currently studying with a Lama/teacher/Guru etc?

Do you do any kind of daily spiritual practice? (for example: prayers, rituals, etc.)

Do you keep a shrine or altar?

What is your history with the Tara Dance?

How is your physical health

Mental Health?

Is there a Tara Dhatu Student Teacher you are working with currently?  Is there somebody in particular you would like to mentor you?

Are you requesting entry into the program as a Student of Tara (self exploration with no commitment to lead meetings) Level 0 or as a Student Teacher interested in Facilitating the dance as a level 1?

Is there anything else that you would like us to know about you?

Date: