FINGER LAKES PERMACULTURE INSTITUTE
Contact Information and Questionnaire

Mail to: 
Finger Lakes Permaculture Institute
PO Box 54
Ithaca, NY 14851

This information can also be completed online.

A $200 deposit for full time certificate course students and 50% deposit for part time students is needed. If a deposit is required for a one-day class or weekend workshop, the amount will be in the course listing. 

You can make checks payable to Finger Lakes Permaculture Institute. 

Contact Information

Name:
Address:


Phone number:
			home:
			work/cell:

Email address:

 
Date of Birth: 


Enrolling as:		___ Full Time		___ Part Time






Questions (so we can get to know you!)

Please answer the following questions. Feel free to attach additional sheets. Either handwriting or typing is fine. 

1.How did you learn about the course?




2.Briefly describe how your educational or personal journey has brought you to be interested in this course .




3.What skills/qualities/knowledge would you like to acquire through this course?




4.What skills or passions do you have that you would like to share with other students and instructors?





5.You will be in an environment where you will have the opportunity to look at and take responsibility for your own behavior patterns. How committed are you to utilizing this opportunity?




6.Do you have any health problems, special needs or addictions?





8.How do you see your role in creating a sustainable world culture?







9.Is there anything else that you think we should know, or that you would like us to know about you?