New Student Questionnaire

This New Student Questionnaire is to be completed by people who attend one of our courses or classes in person.  

Please take a few minutes to answer these questions. Your answers will help me, your teacher, better serve you during the course. Please answer honestly. You may answer these questions anonymously if that makes you feel more comfortable being honest.

You can complete the New Student Questionnaire in one of two ways:

1.    You can fill out the online form below.

2.    Download and print a PDF of the New Student Questionnaire, fill it out, and give it to your instructor on the first day of class.

If you have any questions, please contact us. Thank you!

New Student Questionnaire

What is the start date of that course or event?
What is the start date of that course or event?
Overall, how much time and energy have you spent addressing your concerns mentioned in the previous questions?
Overall, how successful have your efforts been in addressing your concerns?
How frequently do you feel: Hatred or anger?
Fear or worry?
Embarrassment?
Shame or guilt?
Envy or jealousy?
Sadness or depression?
Stress or anxiety?
Tired or exhausted?
Restless or distracted?
Overwhelm or frustration?
How frequently do you feel: Awe or wonder?
Grateful or appreciative?
Love or kindess for someone?
Peace, calm, or ease?
Joy or happiness?
Compassion or tenderness for someone?
Contentment or ease?
Curiosity or interest?
Alert and energetic?
Confident or competent?
Focused or undistracted?
How much of your disappointment and unhappiness do you see as being self-inflicted?
How important is religion or spirituality in your life?
On average, how many times a week do you meditate?