Application: Mindfulness Level 1

Mindfulness Foundations

You must have completed an 8 week MBSR/MBCT/MBI course before you can apply for this CMI Teacher Training. Please answer every question clearly as we assess the suitability of the course by your application and will inform the decision whether or not you are offered a place.

All information is stored in complete confidence and by submitting this information you agree for CMI to share with the necessary CMI team members to deliver the required training.

Please indicate which dates you are applying for:

25th - 30th September 2017

Name*

Surname*

Date of Birth (YYYY-MM-DD)

Email*

Contact Number

Gender
MaleFemale

Ethnicity

Address*

Street

Town*

County*

Postcode*

Do you take any movement based practice?
(Yoga/Tai Chi/Qi Gong) Please give details.

How long have you practiced?

Do you teach movement practices?
YesNo

For movement teachers only:

If yes, how long have you taught?

Do you have any experience of teaching meditation?

Please list qualifications & with whom you trained and other qualifications that you feel are relevant

Do you have any physical limitations that may affect your ability to take movement practice?

Have you had or do you have any mental health issues that you feel we need to be aware of in terms of taking introspective practices? (anxiety or depression)

Are you currently taking any medication?

Kindly provide details of your experience of teaching breath work and/or meditation.

What is your experience of Mindfulness?

What form does your daily practice take? (formal and informal)

Why do you practice?

Please provide the Date, Trainer and Place of your 8-week MBSR/MBCT/MBI course

If the past course was not delivered by CMI, please provide contact details for the organisation/teacher who provided the course

If you have provided contact details above, would you be happy for us to contact this person for a reference?
YesNo

Please outline any other Mindfulness courses, training or retreats you have already undertaken

Please indicate what has drawn you to this course

Is there any additional information you would like to share?

Thank you for taking the time to complete this application form.
All information will be treated in the strictest of confidence.

Payment and Cancellation Information

We will be in touch to arrange payment.

Cancellation

Within two weeks of the course start, no refund will be offered for cancellations. Prior to this, 50% of the course fee will be refunded.

If sufficient notice is provided, and at the discretion of CMI, every effort will be made to transfer your application to another course, minus the admin fees.

Places on this course are limited. Please apply early to avoid disappointment.

Those wait listed will be informed as soon as places become available.

Kindly tick to acknowledge that you understand and accept the payment and cancellation policy of CMI and that you wish to apply for the above event.

The CMI Admin Team will communicate with you by email and provide an electronic receipt.