Language
English (US)
Chinese (Traditional Han)
Vietnamese
Korean
Three Refuge & Five Precept Application
三皈五戒申請表
I am applying for
*
Three Refuge
Five Precepts
Who did you consult with
*
Master XianXin (XX)
Master XianZhi (Master Z)
Master XianChi (XC, old monk)
Ven. XianWen (XW)
Ven. XianShun (XS)
Ven. XianFa (XF)
Ven. XianAn (XA)
Full Name (English)
*
First Name
Middle Name
Last Name
Preferred Name (Any Language)
Gender at Birth
*
Male
Female
Other
Explain if selected "Other" above
*
Pronoun
Birthday
*
-
Month
-
Day
Year
Nationality
*
What's your citizenship status?
*
US Citizen
Korean Citizen
Other (Visa/Green card)
If selected "Other" above, please specify the type of your visa
*
Birth Place
*
Email
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
High School (Name/Place/Year Grad.)
College (Name/Place/Degree/Year Grad.)
Marital Status
*
Single
Married
Divorced
Other
Explain if selected "Other" above
*
Number of Children if any
Have you taken Refuge?
*
YES
NO
If you have taken refuge, please elaborate WHEN/WHERE/Under which Master?
Have you taken Five Precepts?
*
YES
NO
If you have taken Five Precepts, please elaborate WHEN/WHERE/Under which Master?
Please add your comments and reasons for applying for taking refuge/precepts:
Applicant Signature
*
Date
.
Month
.
Day
Year
Submit a recent photo (2x2) with a clear image of your face. This photo will be used on your certification of refuge.
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Dharma Name/中文
FOR OFFICE USE ONLY
Dharma Name Translation
Korean Translation
Vietnamese Translation
Dharma Name (Korean/Vietnamese)
FOR OFFICE USE ONLY
Approval Date
.
Month
.
Day
Year
BLI location:
Please Select
Lu Mountain Temple
Wei Mountain Temple
Gold Forest Chan Meditation Center
Dharma Treasury Temple
Jeweled Mountain Temple
Jeweled Conch Seon Center
Refuge Ceremony Livestream
Refuge Ceremony Date
-
Month
-
Day
Year
Date
[Deprecated] Approved By
[Deprecated] Upload a Signature
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