Form – Course Service Application – North American Vipassana Prison Project

Privacy Policy, Disclosures & Consents
Dhamma.org cares about your privacy. As data protection regulations are updated around the world (including the GDPR in the European Union), we continue to make data protection improvements for the benefit of all Dhamma.org users. This page details how and by whom the data on your application form is handled, as well as requesting your consent to that handling in order to proceed with the application. Please read this page carefully before agreeing to proceed with your application. Contact [email protected] for any further information.
Disclosures

The information you provide on this form will be treated confidentially unless disclosure is required by law. By completing and signing this form, you give your consent to the storage and use of this information by the Vipassana course organizers as described in the Privacy Policy, applicable where the course for which you are applying is being held. A copy of which may be obtained from the course registrar.

Details of the processing of your information
- Your application is being initially received by Dhamma.org which is the initial processor in the registration process relating to your application to participate in a Vipassana Meditation course or other Vipassana Meditation related activity. The contact information for Dhamma.org is [email protected]. Dhamma.org will either pass your application directly to the Center Registrars, or to a Regional Registration Processor (“RRP”) who in turn will pass your application to the Center Registrars. The Course Registrars will be responsible for the handling of your application at the center where the Vipassana Meditation course or other Vipassana Meditation related activity will be held.
- Dhamma.org is hosting its systems infrastructure with Amazon Web Services Ireland Limited, Dublin, Ireland (“AWS”).

Purpose of the processing by Dhamma.org and RRP
- The purpose of the processing of your information by Dhamma.org and by the RRP is to provide your application information to the Center Registrars so that they can carry out the registration process at the Vipassana Meditation Center organizing the course or other activity for which you have applied. Individual Center Registrars include Regular Registrars who receive and process application form data, Assistant Teachers who process applicant information pursuant to preparing for and conducting a course, and/or Special Registrars who handle special circumstances and conditions evident in the application form pursuant to accepting or declining you into a course.
- These steps and procedures are necessary to allow your application to be handled as efficiently and quickly as possible for review by the Vipassana Meditation Center to which you have applied.

Period for which the data will be stored
- Your data will be retained by Dhamma.org on AWS long enough to allow the data to be received from you and transferred to the RRP, or the Course Registrars for access by the Vipassana Meditation Center to which you have applied. This process may take between a few seconds up to minutes or longer depending on the time taken by you to provide required data and the availability and speed of access over the Internet’s wide area network. After successful transfer to RRP or Course Registrars, your application will be purged from AWS by Dhamma.org.
- Following the transfer of your data by Dhamma.org to the RRP, your data will be retained by the RRP in accordance with the data retention policies and procedures of the RRPs. Once your data transfers to the Center Registrars, either directly by Dhamma.org or via RRP, your data will be retained in accordance with the data retention policies and procedures of the Center to which you have applied.

Rights of the Applicant
Pursuant to data protection laws of certain countries, you may have certain rights relating to the data you provide, including the following:
- The right to request access, rectification, and erasure of your data or to object to the processing.
- The right to lodge a complaint with the supervisory authority for your country and to obtain further information regarding details of the controller’s and/or processor’s contact information.
- The right to withdraw your consent.

Voluntary nature of the data input and consequences of failing to provide data
There is no legal obligation for you to provide any of the information in this form. You are providing the information voluntarily and in order to register for a Vipassana Meditation course or other Vipassana Meditation related activity. You have the right to decline to provide Dhamma.org, the RRP and the Center organizing the Vipassana Meditation course or other Vipassana Meditation related activity for which you have applied with this information but in that case, we will not be able to process your application. This is because the information requested is essential to determine your eligibility for the course. This is important for your protection and the protection of other students attending the course.
Consents
- I consent to Dhamma.org handling my data as described in detail in the Disclosures for purposes of making an application for a Vipassana Meditation course or related Vipassana Meditation activity.
- I consent to Dhamma.org processing the information provided by me and keeping the information on AWS for enough time to be able to transfer the data to the RRP or to the Center Registrars of the Center organizing the Vipassana Meditation course or other Vipassana Meditation related activity. For these purposes, “enough time” may last from a few seconds to minutes or longer depending on the time taken to provide required data and the availability and speed of access over the Internet’s wide area network.
- I consent to the transfer of my data from Dhamma.org to the RRP, or directly to the Course Registrars of the Center organizing the Vipassana Meditation course or other Vipassana Meditation related activity so that the data will be available to the appropriate Vipassana Meditation Center for further processing and review.
- I am aware that depending on the course location, there may not be any additional safeguards in place to protect my personal information. I am also aware of the risks that this may cause for the use or loss of my personal information. I confirm that I want to proceed with my application and will not hold Dhamma.org responsible for the loss or misuse of my personal information in the country I apply for.
- I am providing the information requested on this form voluntarily, with the understanding that I may choose not to enter the information at any time in the process of the application and thereby withdraw the application.
- I understand that I have the right to withdraw my consent, in which case my application will not be processed further.
By checking the box below,*
I further acknowledge and agree that any and all information provided in this application for acceptance into a Vipassana Meditation course, or otherwise provided by me to the Vipassana organizations, may be used by the Vipassana organizations for their purposes consistent with their Privacy Policies, as amended from time to time. Our online and general privacy policies are currently available at http://www.dhamma.org/en/privacy.
- Yes, I have read, agree with and accept the terms of the Privacy Policy and the other terms of submission of this application form.

Have you completed a 10-day meditation course?*
At this time, before you can volunteer for the Vipassana Prison Project you must have completed a 10-day Vipassana course. For additional information about 10-day courses, see http://www.dhamma.org. If you have not completed a course, but have a suggestion or question about volunteering, you can contact us at [email protected].
- Yes

Contact Information
Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
General Information
Age*
Date of Birth*
MM slash DD slash YYYY

Volunteers must be 18 years old to participate.
Gender*
- Male
- Female
- Prefer not to say
Do you speak and understand English very well?*
- Yes
- No
Do you speak any other languages?
- Yes
- No
If Yes, which language(s) do you speak and how fluently?
Occupation
Emergency Contact Information
Name*
First Last
Relation*
Phone*
Email*
Enter Email Confirm Email

Course History
Total Number of Courses Sat Full-Time*
Total Number of Courses Served Full-Time*
First Course Sat (Date)*
First Course Sat (Location)*
Teacher(s) Name*

If you do not remember, please write 'unknown'
Most Recent Course Sat (Date)
Most Recent Course Sat (Location)
Teacher(s) Name

If you do not remember, please write 'unknown'.
Other Course(s) Sat
Please provide any additional information you would like to share about courses sat.
Course(s) Served
Please provide any information you would like to share about courses served.
Serving Reference
Please give the name of a teacher or AT with whom you have served a course.*
Date (month & year)
Location*

Confirming Service Form
14. I acknowledge,*
that I have carefully read and understood the Code of Conduct for Dhamma Workers, and I agree to abide by all the rules and regulations while I am at the prison course. I realize that serving on a Vipassana meditation course in a prison is an especially serious undertaking that will require my full mental and physical health.
- Yes
15. I affirm that I believe I am fit to participate in it.*
- Yes
16. I hereby certify that the above information is true to the best of my knowledge.*
- Yes
Signature*

Your Full Name
Today's Date*
MM slash DD slash YYYY

North American Vipassana Prison Project

As taught by S.N. Goenka in the tradition of Sayagyi U Ba Khin

Course Service Application

Privacy Policy, Disclosures & Consents

Disclosures

Details of the processing of your information

Purpose of the processing by Dhamma.org and RRP

Period for which the data will be stored

Rights of the Applicant

Voluntary nature of the data input and consequences of failing to provide data

Consents

For Old Student Volunteers

Contact Information

General Information

Emergency Contact Information

Course History

Serving Reference

Additional Questions

Confirming Service Form