Application Form
Professional Development Courses & Certificate Program at The Centre for Mindfulness Studies
Email address
Name
Your answer
Telephone
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Full Mailing Address
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Which professional development certificate program(s) are you interested in pursuing?
Required
If for a specific course, please indicate which course(s)
PROFESSIONAL CREDENTIALS
Do you have a degree?
If so, in what field/discipline?
Your answer
Do you have an advanced degree?
If so, in what discipline?
Your answer
PREREQUISITES
Have you completed an MBCT / MBSR / smartEducation program as a participant?
Please list the length, location, dates, and facilitator name(s).
Your answer
Have you completed any formal professional mindfulness training?
Please describe the course(s) including stated objectives and list the length, location, dates, and facilitator name(s). For applicants seeking to enrol in a specific course or retreat, make sure to list the required prerequisite(s) and/or their equivalent(s).
Your answer
Have you facilitated (assisted, facilitated alone, or co-facilitated) an MBCT / MBSR / smartEducation program?
Please list the length, location, dates, number of participants, and co-facilitator name(s). Co-Facilitated refers to groups for which you and your co-facilitator had approximately equal levels of experience facilitating MBCT/MBSR programs. Assisted refers to groups for which you were the junior facilitator.
Your answer
MINDFULNESS PRACTICE
Do you have a regular meditation practice?
In 50 words or less, please state the tradition, describe the number of times a week you practice, the typical length of each session, and the number of years you have been practicing.
Your answer
Do you have a mindful movement practice (e.g. yoga, qigong, tai chi)?
In 50 words or less, please state the tradition, describe the number of times a week you practice, the typical length of each session, and the number of years you have been practicing.
Your answer
Have you participated in any facilitator-led silent retreats?
Please list the length, location, dates, and facilitator name(s).
Your answer
STATEMENT OF INTENT
Why do you want to enrol in this professional development certificate program or specific course/retreat?
Please explain in 250 words or less.
Your answer
To complete your application, submit your CV to info@mindfulnessstudies.com
Please send a copy of your CV to info@MindfulnessStudies.com with the Subject Line: “Professional Development Application - CV” and please save it with the title "Last Name_First Name_CV"
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