Level I Application - Questionnaire » Mindfulness Training Institute

First name

Last name

Email Address

Address

City

State, Territory or Region

Phone number

Professional background

Relevant professional qualifications in health, education or other

Group experience as a teacher, trainer or therapist:

Do you have a current mindfulness or other meditation practice? How long have you been practising for? (no. of years)

Please provide details of where, when and the name of the teacher (with email and phone number) with whom you completed an MBSR or MBCT course. There is an expectation that you will have completed all sessions of the course including the All Day if applic

Please provide the name of the teacher of the MBSR/CT course you have attended. They may be asked to act as a referee for this application (name, email and phone number), so please ask them first if they would be willing to be your referee.

Have you completed a Silent Meditation Retreat (at least 5 nights). If yes, where, when and with whom? (If not, please outline your plans to complete this pre-requisite before you attend the training Intensive).

Please outline your yoga or other body-based discipline experience.

Is there a specific population of people that you have expertise in working with, and would like to offer MBSR or MBCT to in the future?

Have you run MBCT or MBSR courses? If yes, how many?

Please write something on the meaning of practice in your life and work, what has drawn you to participate in this program, and your vision or intentions for integrating this into your work. You can use as much space as you like for this.

Which Residential will you be attending : Australia or New Zealand?

Please upload a picture of yourself