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The Passage Application

Application procedure:

  • Complete this form as thoughtfully as possible. It will be kept confidential between William Spear and Ellen Goldsmith.
  • Submit the form by e-mail or print it out and return by postal mail.
  • E-mail or post us a current photograph of yourself in which your face is clearly visible. Our postal address is at the bottom of this form.

You will be promptly notified whether or not your application has been accepted. Participation is limited to individuals whose applications are approved by the facilitators.

Because of the unique nature of The Passage, some time is needed between the date you apply and the date you are accepted. To give you time to plan your schedule and make travel arrangements, we recommend you submit your application as far as possible in advance of the desired workshop.

To offer each participant the greatest potential benefit, family members, significant others and friends accepted into The Passage may be asked to select a Passage at a different location and date than yours.

First Name:
Last Name:
Address:
City:
State (only if USA/Canada):
ZIP or Postal Code:
Country:
Other Country:
Phone:
Fax:
E-mail:

1. Which Passage are you interested in attending?
Date and Location:

2. If you have already attended The Passage, which one(s)?
Location:
Date:

3. Do you know anybody else who is applying for this Passage?
Name:
Relationship:

4. Why do you want to attend The Passage?


5. How did you learn about The Passage?


6. Are you involved with any therapeutic work, either individual or group?


7. Have you ever been hospitalized for depression or other psychologically-related illness? If so, please explain.


8. Are you currently taking any medication or using drugs of any type?


9. What is your work, marital status, family and living situation?


10. What are the main issues prevalent in your life at this time?


11. Are there any medical or psychological issues which you feel may affect your full participation?

Submit now or print out and return by postal mail to:

Fortunate Blessings Foundation
24 Village Green Drive
Litchfield, CT 06759-3419
USA


Please remember to (e)mail us a photograph of yourself.
 

©2008 Fortunate Blessings Foundation, Inc.
All Rights Reserved.