Preliminary Screening Questionnaire

Kindly answer the following set of questions in a true spirit of honesty and not to
impress anyone (least yourself), but as a powerful reminder to your own self, so to
understand and acknowledge your present state of being. Please note, you cant
leave any of the questions unanswered. Please be elaborate wherever needed.

1. What is your intent for taking up the course?

2. Are you currently practicing any healing arts and/or for how long?

3. Which of the following (-) emotions are predominant currently?

a. Fear

b. Anger

c. Sadness

e. Hate

f. Distrust

g. Guilt

h. Doubt

i. Confusion

j. Others (Please Specify)

4. Which of the following (+) emotions are predominant currently?

a. Love

b. Hope

c. Faith

d. Patience

e. Calm

f. Happiness

g. Togetherness

h. Contentment

i. Amusement

j. Others (Please Specify)

5. Which of the following virtues you wish to add?

a. Love

b. Peace

c. Compassion

d. Patience

e. Discipline

f. Contentment

g. Detachment

h. Faith

i. Generosity

6. If you have to the power to change yourself, what would you change?
7. If you had the power to change the world, what would you change?

8. Will you be in a position to dedicate time (15 - 20 minutes) each day for the next 3 months
towards Study and Meditation?

9. What does this symbol speak to you? Please explain?

9. Are you willing to change your beliefs (the way you view the world and yourself) in exchange of
new informed ones?

10. Do you agree to be a student of the Esoteric Sciences?

11. Lastly, please describe yourself in detail? (This question is intended to understand, how much
you know about yourself as a Human Being and please do not list your Accomplishments,
Profession, Age, Hobbies, Family History etc.)

Do you hereby agree to abide by the terms and conditions of the Course and will strive hard to
do full justice to the Knowledge and Wisdom being offered. Do you promise to keep an open
mind of a Student at all times.

Name: First Name + Last Name

Date of Birth: DD MM YYYY

Current Place of Residence: