Application Questionnaire

SECTION A

(Real) Name______________________________________

(Craft) Name_____________________________________

Birth date:__-__-__ Phone #___-___-____

Email Address:_____________________________

Street Address:_________________________________

City:___________________ State:__________ Zip:________


Please answer the following questions the best you can:

How long have you been interested in the Craft/Paganism?_________________________________________

What traditions or paths are you most interested in?_________________________________________________________________________________________________________________________________________________________________________

Do you consider yourself a beginner?_____________________________________________________________________________________________________________

Please list all covens or study groups you have been apart of past and present. Include all dedications, initiations, affiliations, memberships, classes, etc.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What would you like to learn more about?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are you ordained?_______________________________________

What conflicts, work schedules, or other personal commitments do you have that would interfere with coven meetings and/or training?______________________________________________________________________________________________________________________________________________________________________

Do you smoke, drink, or take drugs (NOTE: you don't lose points for being honest)?________________________________________________________

Are you allergic to any of the following: cats, incense, oils, nuts, fruit, juice, wine, or any other important allergies________________________________________________

List any health conditions:____________________________________________________________________________________________________________________________________________________________________


SECTION B

WITCHCRAFT/PAGAN Terms:

For the following please answer honestly using a Y for YES, N for NO, and S for SOMEWHAT in the blanks next to the word.

Are you familiar with what these words mean?

__athame
__book of shadows
__chalice
__censer
__boline
__circle casting
__cauldron
__pentagram
__amulet
__talisman
__besom
__pendulum
__deity
__elemental spirits
__sylphs
__gnome
__undine
__salamander
__OBE/Astral projection
__Beltane
__Samhain
__Imbolc
__Lammas
__Mabon
__Ostara
__Yule
__cone of power
__deosil
__widdershins
__esbat
__sabbat
__handfasting
__handparting
__libation
__sacred space


SECTION C

PLEASE DO NOT ANSWER SECTION C UNTIL YOU GO OVER ALL STUDENT AND MEMBERSHIP INFORMATION

***********************************************************

Please check one of the following:

You are interested in...

__student training to become a member

__student training to learn more about Paganism and/or Witchcraft but not become a member

__membership as a non-beginner

__branch-membership as a non-beginner

__none of the above

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Please check one of the following:

__I am interested and would like to go on to the next step.

__I would like to think about it and I will get back to you by__/__/__(enter date)

__I am NOT interested at this time but keep me in mind for future open houses and/or events.

__I am NOT interested and do NOT wish to receive any more announcements.

You can contact the Coven of the Mystic Grove by any of the following:

Email: Justice10-6@webtv.net

Website: http://embark.to/MysticGrove

Snail Mail: C.o.t.M.G., PO BOX 188, Villas, NJ 08251

Phone: Donna Worby @ 609-889-7624

Blessed Be the Goddess Within, Blessed Be the God Within, Blessed Be your Heart!


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