City Center Residential Practice Period Application
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Page 1
SAN FRANCISCO ZEN CENTER CITY CENTER
Winter 2023 Residential Practice Period Application
January 24th - April 1, 2023
Led by Ryushin Paul Haller
Fields marked with an
*
asterisk are required.
NOTE
: You are applying to participate as a
Residential Participant
(residing at 300 Page St /City Center for the duration of the Practice Period).
Personal Information
First Name
Last Name
Email
Date of Birth
Use month/day/year with 4-digit year
Phone (Cell)
Alternate Phone
I identify my gender as (for housing purposes)
Gender Pronouns (i.e. he/him, she/her, they/their, or something else?)
Address
Mailing Street
Mailing City
Country
Please select...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos ( Keeling ) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Côte d ' Ivoire
Croatia ( Hrvatska )
Cuba
Cyprus
Czech Republic
Congo ( DRC )
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands ( Islas Malvinas )
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé and Prìncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Virgin Islands ( British )
Virgin Islands
Wallis and Futuna
Yemen
Zambia
Zimbabwe
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Province
Please select...
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Zip / Postal Code
Emergency Contact Information
Emergency Contact Name
Relationship
Please select...
Significant Other
Parent
Child
Other
Address
Cell Phone
Alternate Phone
Email
PART II: Personal Statement
What motivates you to join this practice period? For instance, what is it you are searching for, inspired by, or would like to investigate in your life?
A brief personal history, and specifically, what do you consider to be the most important manifestations of your Buddhist practice in your everyday life? What do you do and / or have done - in your work life, in family life, in the larger world, in the monastery - that you consider to be an important manifestation of your commitment to Buddhist practice?
Completed SFZC Practice Periods, intensives and sesshins and dates (if applicable)
Briefly include other formal Buddhist practice experience; include date(s), and location(s)
Have you received the Buddhist precepts?
Please select...
Yes
No
Date Received Precepts
Received Precepts from whom?
Have you been ordained as a Buddhist priest?
Please select...
Yes
No
Ordination Date
Ordained by whom?
Are you currently practicing with a Buddhist teacher or practice leader?
Yes
No
Name of Primary Teacher/Practice Leader
Are they an SF Zen Center Teacher?
Yes
No
We request a letter of recommendation from your teacher if they are not a SF Zen Center teacher. Please provide contact information so that we may reach your teacher if necessary. Please include the teacher's name, address and phone number.
Preferred Zendo Seating Type
Please select...
Zafu/Zabuton
Chair
Other
If Other type seating describe/explain
In order to help with the assignment of housing, please indicate if you snore or use a CPAP machine.
Page 2
Medical
Any medical problems such as back or knee problems, repetitive stress (RSI), food or other serious allergies?
Do you have any significant physical, psychological, or emotional difficulties, particularly those for which you have received professional help or been hospitalized (Please list dates, if applicable)?
Do you have a history of alcohol or substance abuse (Please list any treatment programs and dates)?
Please specify any perscription medications, and briefly describe the conditions being treated.
Any limitations that would prevent you from completely following the practice period schedule?
Vaccinations
At this time, City Center is only able to invite people to be residents who are fully vaccinated and have received a booster shot when eligible.
Do you have a current flu shot?
Please select...
Yes
No
Are you able to get a flu shot before the start of the practice period?
Please select...
Yes
No
Have you been vaccinated against Covid-19?
Please select...
Yes
No
Will you be fully vaccinated by the start of the practice period?
Are you able to completely follow the
Covid-19 protocols
while at City Center?
Please select...
Yes
No
What vaccine did you receive? How many doses have you received and what was the date of your last dose?
Travel/Stay (residential applicants)
Will you be catching a flight or traveling via public transport within 14 days of your arrival?
Please select...
Yes
No
How will you support yourself during your stay at City Center? What are your plans following the practice period?
Are you interested in continuing in residential practice at City Center after this practice period?
Please select...
Yes
No
How long to you intend to stay in residence at City Center?
Please select...
3-6 months
6-12 months
1-2 years
more than 2 years
Describe your interests and/or intentions if continuing residential practice at City Center
Page 3: Participation in the Practice Period
Full participation in a City Center practice period requires:
Monday through Saturday attendance at morning and evening meditation, service, and temple cleaning
Attendance at twice-weekly dharma talks, a weekly class, formal oryoki meals and ceremonies
Weekly meal preparation and dishwashing shifts and temple jobs
Following the
City Center Practice Guidelines
Refraining from recreational drug and alcohol use
Refraining from beginning any new sexual relationship
Note: the times and offerings here may vary from the final schedule but give you a good idea of what our time together will look like. Final details of the schedule will be provided with confirmation materials.
Please designate your level of involvement in the Practice Period
Residential applicants apply to take part in either a "full" schedule or a "limited" schedule. The "full" schedule involves working in the temple full-time (Monday through Friday for a full work day). The "limited" option allows participants to live in the temple, but without taking up full-time temple work, such that the participant can continue engaging in their normal livelihood. Please indicate your preference by marking the appropriate option.
Full Schedule
Limited Schedule
Full Schedule (WPA)
Shared Room
Private Room (availability is limited and reserved first for those with
special needs)
Limited Schedule
Shared Room
Private Room (availability is limited and reserved first for those with
special needs)
I have read, understood, and kept a copy of the
P
ure Standards for Residential Zen Training
, and reviewed the
practice period schedule
.
If accepted, I agree to observe the guidelines and participate fully in the practice period.
Agreed
Page 4
Payment
Payment is full is required before arrival at
City Center
unless another arrangement is made in advance. See the
Intensive webpage
for fees.
Application Fee
Are you currently an SFZC Resident (at Green Gulch, City Center or Tassajara)?
Yes
No
Payment of $30 may be paid here. Visa/MC only.
Name on Card
Card Number
MM
YY
Code
Billing Email
Please upload a recent, cropped headshot. There is a free online cropping tool at
cropp.me
.
Upload a photo from your device
All first-time residential applicants are required to meet with the City Center Director prior to the application due date. If a physical meeting is not practical, a Zoom or telephone appointment can be made. You will be contacted to find a mutually convenient time for this meeting. If you have any questions about financial assistance, work exchange, or any other matters related to the application process, please contact the temple coordinator at
ellen.simpson@sfzc.org
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