Earth School Shamanic Gatekeeper Training Application Form

I am applying for the following training: Check ALL that apply I am applying for the following training: Check ALL that apply Full Apprentice Gatekeeper Training inclusive of all 6 Modules: (Ongoing) Gateway One: FIRE (July 2023, January 2024) Gateway Two: WATER (August 2023, February 2024) Gateway Three: EARTH (September 2023, March 2024) Gateway Four: NATURE (October 2023, April 2024) Gateway Five: STONE (November 2023, May 2024) Integration Month (December 2023, June 2024)

Name

Surname

Gender GenderMaleFemaleNon-BinaryOther

Age Age21-2829-3536-4243-4950-5657-6263-70over 70

Email Address

Phone Number

Complete Physical Address (we may need to mail you materials during the training):

Country

Nationality

Home Language

Medical Information: Given the nature of the Elemental and transformational work it would be helpful to be aware of your general state of health. All information will be held with the strictest confidentiality. Please enter “In Good Health” if you have no relevant health concerns that the facilitators should be aware of. For example: Are you taking any psychiatric medication, antidepressants, heart or blood pressure medications? Do you suffer from migraines? Do you struggle with stress and/or sleep deprivation? etc. ?

Highest Formal Education

Personal Interests / Hobbies

Describe your Intention and Motivation to receive training

Describe your character

Volunteer or Service Experience

List any Healing, Self-Improvement Workshops, Retreats, or Therapies you have partaken in:

Do you have a meditation practice?: If so, please describe your practice and frequency / minutes per week? Type NONE if you are a beginner

What experience do you have with shamanism or working directly with Nature’s Wisdom/Medicine? Please include any natural medicines you engage in and the frequency. Type NONE if you are a beginner.

Tell us who or what most inspires you: We would like to know who or what you look to for encouragement, character, inspiration.

Describe a moment when you were very INSPIRED: Describe in detail a moment when you felt deeply inspired to do or create something important to you. What was the idea/feeling all about? What did you do to manifest into reality your vision? Did you succeed? What journey did it take you on? And what important life lessons did you learn along the way?

What would you say is the highest priority challenge facing humankind at present?

If you had the means, how would you set about catalysing meaningful change?

What immediate LIFE challenges are you facing that you’d care to share?

How did you hear about Earth School?

Have you participated in any of these Earth School offerings? Please check ALL that apply: Have you participated in any of these Earth School offerings? Please check ALL that apply: Meditation (Zazen) TrainingTalking Circle (Council Training) Heart-to-Heart Mentoring Private Divination Online Q & A Session Contributed to the Dana or YES Fund Donated to Plant a Tree

Have you read our DANA and YES Fund page on our Website? Have you read our DANA and YES Fund page on our Website?YesNo

The suggested Dana Donation is R1000-2000 per module or R5000-10000 for all 6 Modules. Please check ALL that apply: The suggested Dana Donation is R1000-2000 per module or R5000-10000 for all 6 Modules. Please check ALL that apply: am grateful to be able to afford the Dana Donation can afford the Dana Donation but would like a payment plan (Monthly payment plan only for full program) I cannot afford the Dana Donation but would like to offer my skills in exchange I cannot afford the Dana Donation and intend to apply for a Scholarship to cover the Dana Donation

Anything else you would like to tell us?

Do you have regular and reliable access to the internet for the Online training? Do you have regular and reliable access to the internet for the Online training?YesNo

Do you have a Universal Power Supply to keep you Online during Load-shedding? Do you have a Universal Power Supply to keep you Online during Load-shedding?YesNoWill Acquire One

By submitting this application form you agree that Glenn (Nangaku) Leisching / Born as the Earth Zen School can process and securely record your information. By submitting this application form you agree that Glenn (Nangaku) Leisching / Born as the Earth Zen School can process and securely record your information. I agree