Student Application for admittance to Tien Shan Hermitage

Please answer the questions and return via email.

1. Name

2. Age

3. Date of arrival and length of stay.

4. What are the goals and motivations that you have for learning our Nei Kung in depth and what particular aspects interest you most?

5. What is your past exposure to chi kung, tai chi, similar arts, self defense, meditation, hiking, or yoga?

6. Do you have a practice or type of exercise that you do currently, if so, what?

7. Is your lifestyle mostly sedentary , moderately active, very active, athletic?

8. Height and Weight

9. Location of last primary residence.

10. Emergency contact info for a primary family or friend.

11. If you have any medical problems or health concerns, any limitations of movement, any surgeries, please explain.

12. Are you taking any prescription or alternative medicines?

13. Do you have experience with gardening or construction?

14. Include a picture of yourself or link to a Facebook page with your picture.

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