Alternative Module Request: Intensives & Retreats
You may request that an alternative course or work experience be considered as a replacement for required training as part of the MBCT or MBSR Facilitation Certificate Program by completing this form and submitting payment.
To assess the equivalent of an intensive (e.g. MBCT Intensive Training & Retreat, MBSR Intensive Training & Retreat), the fee is $80.
NOTE: alternative module assessment fees are non-refundable, regardless of the outcome of your request.
• Mail us a cheque made out to "The Centre for Mindfulness Studies"
• Drop by our office with a cash or cheque payment
• Make the payment on Ticketleap at
As a charity, we do not charge HST. However, payments made via TicketLeap are subject to a transaction fee.
Your Full Name
Phone Number (###-###-####)
Module to be considered for replacement
MBCT Intensive Training & Retreat
MBSR Intensive Training & Retreat
Advanced Teacher Training Intensive
Other - please specify as part of the description provided below
Description of alternative training/instruction
Date Completed (approximate date is fine)
Hours of Training
Name of Facilitator or Supervisor
Send me a copy of my responses.
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