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work study program application


please print legibly. First Name _____________________________________ Last Name __________________________________________________ oMale oFemale Today’s Date ________________________


Phone: Evening (—————)______________________________________Day (—————)______________________________________ Cell (—————)_______________________________________ Home Address __________________________________________________________________________ City/State/Zip __________________________________________________________________________ Country _____________________________Occupation (previous, if retired) ____________________________________________Date of Birth __________________________ Age ___________


mo / day / yr


E-mail Address____________________________________________________________________________________________________________ Do you have any physical/emotional condition (i.e. bad back, severe depression) that might affect your ability to participate? oYes oNo Are you taking medication? oYes oNo If yes to either of these questions, please include details in your personal statement.


Are you a former workscholar? oYes oNo If yes, list dates and the dept. where you worked: _______________________________________________________________


Are you an ILEAD student? oYes oNo If yes, from what school? ____________________________________________________________________________________________________ See www.esalen.org/workshops/workstudy.html for more info about ILEAD.


The Work Study program is for 28 days, beginning at 4 pm on Sunday and ending at 7:30 pm on the final Sunday. Sometimes particular dates and/or leaders are not available. List below, in order of preference, the dates/leaders for which you are available. Please note: Space may become available up until the program start date. You must let us know if you wish to be removed from a wait list; if you’re on a wait list and space becomes available, you will be notified for confirmation. If you cancel after placement, you will be charged a cancellation fee. start date


Choice 1 _______________________________________________________ Leader ____________________________________________ If full, wait list? oYes oNo Choice 2 _______________________________________________________ Leader ____________________________________________ If full, wait list? oYes oNo Choice 3 _______________________________________________________ Leader ____________________________________________ If full, wait list? oYes oNo


If your application is approved and we cannot give you your first choice, we will place you in your next available choice. Workscholars may be invited to remain for a second term, depending on space availability and the needs of the Esalen community. Please indi- cate your availability for such an invitation (no obligation): oNo extension oOne-term extension


We encourage ridesharing. Are you bringing a vehicle? oYes oNo; Are you willing to give a ride? oYes oNo; Receive a ride?oYes oNo; I wish to rideshare from(if different from above address) ______________________________________________________________________________________________________________________________


Assignments to departments are made according to community labor needs (usually kitchen or housekeeping). However, if you prefer house- keeping or kitchen, or if you have landscaping skills, please list them below. oPlace me wherever I’m most needed – or – note my preferences below.


Choice 1 ___________________________________________________ Skills/Experience ________________________________________________________________________________________________________


Choice 2 ___________________________________________________ Skills/Experience ________________________________________________________________________________________________________ Please attach a personal statement about your interest in the Work Study program, telling us why you’d like to participate and what you hope to take with you when you leave.


All applicants are required to sign a standard release-from-liability and assumption-of-risk form as a condition of participation in the Work Study program. This form will be mailed to you upon acceptance to the program.


Do you want van service? Van service rates are subject to change. From oMonterey Airport, 2 pm ($50); oMonterey Transit, 2:20 pm ($50); oSan Francisco Airport, 11:45 am($100).


Payment o$400 deposit o$1,150 oCheck (U.S. banks only), attached and payable to Esalen Institute oMasterCard oVISA oAmerican Express


If you are making a credit card deposit, the balance will be automatically charged to your card five days before your arrival.


Applications cannot be considered without a deposit and a personal statement included. Deposits are not processed until your final acceptance into the program.


Name on Card_______________________________________________________________________________ Card No. ______________________________________________________________________________________ Expiration Date_____________________________________________________________________________ Billing Zipcode___________________________ CVV (security) code ______________________


Name and phone number (if different from above): ________________________________________________________________________________________ ________________________________________________________________________________________ Authorizing Signature ____________________________________________________________________


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