The Beginning Experience Weekend
Application



                                         B.E. of Eastern North Dakota   

Today’s Date: _____________   Local B.E. Area Affiliated with: _________________________

Date of Beginning Experience Weekend applying to attend: ______________________________

Last Name: ___________________   First Name: ____________________________________





 



Address: _______________________________________________________________________

 

City: ________________________________ State: ___________ Zip Code: __________________

 

Home Phone:  (____) __________Business Phone:  (____) ___________e-mail: ______________

 

Male: _____ Female: _____ Religious Affiliation:  ___________________Birthdate: ___________

 

Number of Children: _____ Ages of Children:  _________________________________________

 

Separated _____how long ago? ______________________ married for how long? _____________

 

Divorced _____ how long ago? ______________________ married for how long? _____________

 

Widowed _____how long ago? ______________________ married for how long? _____________

 

Never married ______

 

  1. How did you hear about the Beginning Experience Weekend?  (Please include names of friends or

acquaintances who have attended  a B.E. Weekend and / or names of persons you have spoken to about

your readiness to participate in a Weekend.)_______________________________________________

 

__________________________________________________________________________________

__________________________________________________________________________________

 

  1. Local Beginning Experience Levels Attended -  Which Local Area (s)?_______________________

 

Level # : _____ Date: ____________Name of Level Coordinator: _________________________________

 

Level # : _____ Date: ____________ Name of Level Coordinator: ________________________________

 

Level # : _____ Date: ____________ Name of Level Coordinator: ________________________________

 

  1. Are you presently in counseling or therapy? _____ With whom? Name: _______________________

 

Address: ______________________________________________________________________________

Please obtain a written acknowledgment from your counselor or therapist that you are ready to participate in

a B.E. Weekend.  This can be mailed directly to the address at the end of this form or included with this

application.

 

  1. Do you have any special dietary, health, or medical concerns we should be aware of ? ________________

 

Please explain: _______________________________________________________________________________

 

____________________________________________________________________________________________

____________________________________________________________________________________________

 

  1. Do you have friends, relatives, or acquaintances attending this B.E. Weekend ? _____________________

Please list their names:

 

________________________________________     ________________________________________________

 

________________________________________     ________________________________________________

 

6.  The total cost of the B.E. Weekend is $130.00 ( This includes the cost of housing, meals, materials, and

dues to B.E. International.  No team members are paid.  They donate their time, effort, mileage, even long

distance calls).  We ask that a $45.00 deposit be paid with this application.  The balance due may be paid

on the B.E. Weekend or you may work out a payment plan at the time of the Weekend.

 

NO ONE IS TURNED AWAY FROM THE B.E. WEEKEND BECAUSE OF INABILITY

TO PAY.  If the cost of the B.E. Weekend is a hardship for you, please talk to one of your local B.E. leaders.

Scholarship funds are available or a payment plan can be worked out.

 

Near the end of the Weekend, you will be asked for your final payment.  A plea will also be made for additional donations.  We encourage those who can, to give financial support to the Weekend.  This additional support is not only used to support B.E. in general, but it is the primary source of our scholarship funds which allow individuals with financial hardship to attend a B.E. Weekend.

 

______________Enclosed is payment in full. ($130.00)

 

______________ Enclosed is my $45.00 deposit, the balance is to be paid at the Weekend. 

                             (Checks payable to:  Beginning Experience of Eastern N.D.)

 

_______________ I need information about financing options.

 

Applications are accepted on a first-come, first-served basis.  After your application has been processed, you will receive confirmation that you have been accepted to attend the B.E. Weekend.  At that time you will also receive a list of items to bring and directions to the Weekend location.

 

Please list any questions or concerns: ________________________________________________________________________________

______________________________________________________________________________________________________________

 

Return this form to:      Beginning Experience of Eastern N.D.

                                  P.O. Box 608

                                  Fargo, ND  58107                              If you have questions, call or contact a local B. E. leader

 


 

Beginning Experience

of Eastern North Dakota

 

Counselor/Therapist Approval Form

 

After reviewing the Beginning Experience Weekend process as it applies to my client, (name)_________________________________,

it is my professional opinion that he/she be ACCEPTED to attend.

 

 

It is my recommendation that my client, name______________________________________  NOT be accepted
    to participate in a Beginning Experience Weekend at this time.

 

 

SIGNED:___________________________________

 

Date:_________________________________________________

 

 

Counselor/Therapist   Name:_____________________________________

 

                                    Address:_________________________________

 

                                   _________________________________________

 

                                    Telephone #:_________________________

 

Please return this form immediately to:       Beginning Experience of Eastern N.D.

                                                               Box 608

                                                               Fargo, ND 58107