This application is for:
Khidmat (Spiritual Service and Study) Rent Paying Resident
Date I'd like to arrive Month: Day: Year:
Probable length of stay

Personal Information:

Last Name: First Name Middle Name
Name you like to be called
Legal Name if different from Above: Last Middle First
Address
Address
City State Zip/Postal Code
Home Telephone Work Telephone Other Telephone
Email Address
Gender Female Male
Date of Birth (MM/DD/YYYY)
Emergency Contact (Please give name and relationship to you and at least three ways to contact)

Are you currently an initiate in the Sufi Order International? Yes No
If yes are you actively working with a teacher/guide? Yes No
Marital Status Single Married Divorced Partnered
Education (Check Highest Completed) High School Some College College Degree Advanced Degree Other
If "other" please explain
Please list any training, skills, work experience, or licenses you would like us to know about:

U.S. Legal Status: US Citizen Resident Alien Foreign Visitor Other
If other please explain:

Health Concerns:
Please describe your overall health:
In the past year, how many days were you unable to attend work, school, or function in your daily life due to illness?
Are there any allergies from which you suffer, particularly environmental or food sensitivities? Yes No
If yes please describe:
Are you currently under the care of a physician for any acute or chronic conditions? Yes No
If yes please explain:
Are you currently taking any prescribed medications? Yes
Have you ever been hospitalized for psychiatric reasons? Yes
Have you ever had psychiatric care in other environments? Yes
Have you ever had in-house treatment for substance abuse? Yes
If you have answered yes to any of these questions please explain fully the circumstances and outcome of these treatments:

Judicial Concerns:
Have you ever been arrested? Yes No
Have you ever been convicted? Yes No
If you answered yes to either of these questions please explain fully the circumstances and outcome of the arrest and/or conviction:

About you:

Below are listed some questions, the answers to which would allow us to learn something more about you and also to help clarify your vision about living here at The Abode, your hopes, needs and desires. Be as thorough as you need.

How did you find out about the Abode of the Message? Please be as specific as possible. If someone recommended the Abode of the Message to you, please indicate that and who they are.

What is your motivation for coming to live at the Abode?

What does spirituality mean to you?

If you are not an initiate in this Order, are you actively involved in another spiritual tradition? and if so, what?

Please read the following quote from Pir Zia Inayat Khan and respond in the space given below.

"The Abode welcomes all sincere seekers who are able to live in harmony with the community. A visitor or Khadim is welcome to reside for a full year on this basis. If after one year the visitor's life path is in alignment with the purposes of the Abode as a Sufi spiritual community, he or she is eligible to apply for family membership. Alignment with the purposes of the Abode is indicated by both of the following:

A. That one is actively pursuing a spiritual path.
Example 1- That one meets regularly with a guide on
the path that one is pursuing, whether it be the Sufi
Order or another spiritual path.
Example 2 - That one is committed to a consistent
regimen of inner practice.

B. That one participates, in some capacity, in the
spiritual life of the Abode community."

Please describe your present life style, highlighting any current challenges that you are working with in all the areas of work, social activities, primary relationships and other concerns.

Interests and Knowledge

Which areas of work interest you the most? (please check all that are applicable)

Comments on work interests:

If none of the above interests you, is there another area of expertise that you have, that would be of benefit to the community and that you wish to offer?

Please describe your experience with living in community.

What do you see yourself gaining from living in this particular community?

What are your plans if you do not stay at the Abode of the Message?

References:
Please list three references, if you are applying for Khidmat at least one reference should be work related.
Name: Phone:
Email:
Address:
Address:
City: , State: Postal Code:
Name: Phone:
Email:
Address:
Address:
City: , State: Postal Code:
Name: Phone:
Email:
Address:
Address:
City: , State: Postal Code:

Residence Information:
Are you applying for Long-term visitor status? Yes No
Are you bringing any children with you? Yes No
If yes then please give Names and ages

Thank you for your time and attention in completing this application.
In service and peace,

The Residence Committee of the Abode of the Message