What is your name, Dharma name, or both?
Please provide your email for conference communications. It will not be shared. There will be a chance during the conference to add your name and contact information to an ABCC directory.
Email
What is your current occupation(s) including unpaid responsibilities?
What Buddhist caregiving roles do you perform in your community?
Buddhist Counselor
Buddhist Chaplain
Buddhist Informed Psychotherapist
Buddhist Spiritual Director (this can include monastics offering consultations)
Buddhist or Buddhist Informed Addiction Specialist
Dharma Teacher
Meditation Teacher
Buddhist or Buddhist Informed Organizer/Activist
Monastic Duties
Divination (e.g. astrology, tarot, I Ching, etc.)
Other:
Comments:
What training have you done to perform your role?
Residential training at a monastery or Dharma center
Clinical Pastoral Education
Addiction recovery training
Graduate degree in psychotherapy, social work, or pastoral counseling
Supervised clinical training
Divination training (e.g. astrology, tarot, I Ching, etc.)
Organizing/Activism
Master of Divinity degree
Graduate degree in another field
Other:
Comments:
What if any professional licenses or certifications do you have?
What if any ordination or teaching empowerment do you hold and with what lineage?
Where does your caretaking take place?
Buddhist temple
Hospital
Prison
University
Private counseling practice or counseling center
Military
Meditation center
Hospice
Disaster relief
Other:
Comments:
What further training would you like to do?
Which of the following committees would you like to participate in a the conference?
Buddhist Counseling and Buddhist Informed Psychotherapy
Buddhist Chaplaincy
Buddhist Spiritual Direction
Buddhist and Buddhist Informed Addiction Counseling
Buddhist and Buddhist Informed Organizing/Activism
ABCC Code of Ethics
Divination (Astrology, Tarot, I-Ching, etc.)
Other:
Comments: