YU:EXIST Enrollment Form

Thank you for your interest in YU:EXIST. Please share your responses below.

Note: your privacy is always respected and any information that is shared will be honored with confidentiality.

Name

First Name

Last Name

Pronoun

Profession

Location

How did you learn about YU?

Why do you want to enroll in YU? What are you wanting to receive from this experience?

Have you explored the topics of mortality and death before? How comfortable are you with these topics?

What days can you commit to meeting for two hours each week? Please mark all available dates.

4 Consecutive Tuesdays: 11/12, 11/19, 11/26, 12/3

4 Consecutive Wednesdays: 11/13, 11/20, 11/27, 12/4

What time(s) can you commit to meeting each week? Please mark all available times.

6-8pm EST

7-9pm EST

8-10pm EST

We will be discussing sensitive and potentially triggering topics such as mortality and death. Please include any relevant information that I should know prior to you starting YU.

If you'd prefer to talk over Zoom, let me know below.

Share any questions, concerns or comments here.

Before we can work together, please note BACII's terms of service and this waiver: "BACII's services and recommendations are never meant to replace professional legal, medical or psychiatric services. Any recommendations or suggestions made do not constitute medical or legal professional advice on any subject matter. BACII/Mangda Sengvanhpheng does not accept any responsibility for any loss, illness or injury which may arise from reliance on information contained in these services. I acknowledge that these services are intended for informative and educational purposes only. I understand that this service does not intend to substitute any legal, medical, psychiatric or other professional services."

I have read the terms and agree to the waiver