Mindful Teachers Teaching Mindfully (MTTM) Application
By Registering for this in-person group course you are engaging in an act of self-compassion, connection, and mindful citizenship, and giving yourself the opportunity to learn skills for managing stress, anxiety, depression, and chronic pain. This course will benefit you and your students in meaningful ways that allow you to show up with non-reactive awareness, and will allow your students to experience the present moment in ways that are nourishing to their minds and spirits. In filling out this form, you enable me to maximize my effectiveness as your course facilitator. Once your application and deposit have been received, the Rocky Mountain Mindfulness Center will contact you to discuss how you can prepare for the course.
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Name
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Date of Birth
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Mailing Address
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Phone number
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Emergency contact name and number
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Occupation/Work status
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Relationship status
Are you currently under medical treatment or supervision?
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Number of surgeries
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Quality of sleep/Number of Hours
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Weight
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Height
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What kind of exercise do you manage to do each week/frequency?
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Cigarettes per day
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Caffeinated drinks per day
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Alcohol/Recreational drug use/frequency
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History of substance abuse (if relevant)
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Are you currently undergoing therapy for mental health reasons? If yes, please explain.
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What three things do you care about most?
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What three things give you the most pleasure in your life?
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What are your three greatest anxieties?
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Is there anything else that you might want me to know about you?
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Thank you for taking the time to fill out this registration form. We will be in contact with you once we receive both the application and course payment. By registering for the Mindful Teachers Teaching Mindfully course, you have already taken a compassionate step towards improved mental health and reduced stress. Congratulations on this act of kindness and we look forward to working with you.
Rocky Mountain Mindfulness Center: A 501(c)3 nonprofit organization dedicated to providing accessible mindfulness programs to populations in need
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