APPLICATION FOR
residential WORKSHOPS

Please read all the information on the workshop description page closely before completing the form below.

To help us evaluate your application, please answer all the required questions thoughtfully.

Workshop name

Please enter the title of the workshop you're applying for.

Workshop start date

Please enter the start date of the workshop you're applying for (for clarity, since sometimes we have more than one of the same type of workshop in a given year).

ABOUT YOU

Name

First Name

Last Name

Please type it carefully to be sure it's correct or we won't be able to reach you.

Your mobile phone number

In case of emergency or last-minute communications. (We respect your privacy.)

Country

(###)

###

####

Age

Gender

female

male

other, or prefer not to say

Pronouns

If you'd like to specify your preferred pronouns, you're welcome to do so here.

Address

Your residential and legal address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nationality

Passport info (for those who are not US citizens)

If you are NOT a citizen of the US, please enter your passport number, country, date of expiry, and place of issue.

Have you been to Earthville Institute before? If so, when and for what purpose?

Tell us something about you. Who are you and what do you care about?

What are your main interests, passions, and values? Who do you aspire to be? What do you aspire to do with your life?

ABOUT YOUR INTEREST IN THE WORKSHOP

Why are you interested to join this workshop?

Please give a thoughtful and detailed response here. What attracts you to this workshop? What kind of experience are you hoping to have? What is it that you hope to learn and take away from it?

Have you done any other programs similar to this? If so, what and where?

Any concerns or physical limitations with regard to physical work?

Are you able and committed to stay for the full duration of the workshop?

Are you potentially interested in staying after the workshop to volunteer if possible?

If so, for how long? If you're not sure, you can say so and just make a guess.

Additional comments

Anything else you'd like to tell us?

GENERAL INFO

Emergency contact

Provide the best person to contact in case of emergency. Please enter the name, phone number, email address, and relationship (e.g. mother, husband, friend). If you'd prefer to give us this info when you arrive, that's OK too, but we prefer to have it just in case.

Food allergies and/or dietary preferences

We serve only healthy, mostly-organic, plant-based (vegan vegetarian) cuisine. We also do our best to accommodate special needs within our limited capacity, so if you are diabetic or have food allergies, gluten intolerance, etc., please let us know so we can do our best to take care of you.

Do you have any injuries, medical conditions, or other health concerns?

This information will remain confidential. Please do inform us fully as it is our responsibility to be aware in case of emergencies. Do you have any allergies or sensitivities? Any physical limitations such as difficulty sitting or walking, back pain, etc.? Any emotional or psychological challenges? If yes to any of the above, please give details.

Medications

This information will remain confidential. Please do inform us fully as it is our responsibility to be aware in case of emergencies. Are you currently taking any medications? If so, which medications and for what conditions?

How did you come to know about Earthville Institute? (Check all that apply)

A friend who has participated in Earthville program(s)

A friend who had heard or read about Earthville

Search engine (Google, etc.)

Instagram

Facebook

Other

Name(s) of person(s) who told you about Earthville Institute

If someone told you about Earthville Institute, what is that person's name?

Just one more step:

After you click the "submit" button below, your application will be sent to us for review. Follow-up questions and/or an online interview are often part of the application process. After we have reviewed your application (normally within 1-2 weeks), we will send you an email that will notify you of your application status (e.g. pending interview, pending receipt of deposit payment, waiting list, etc.).

APPLICATION FORresidential WORKSHOPS

Please read all the information on the workshop description page closely before completing the form below.

To help us evaluate your application, please answer all the required questions thoughtfully.

APPLICATION FOR
residential WORKSHOPS