Mindfulness-Based Supervision and Mentoring Training: Ongoing Learning and Development Workshop: Supporting Supervisees through Feedback and Guidance

Terms & Conditions

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I confirm by ticking this box that I have read the course description and relevant information sheets and understand and agree to the Terms & Conditions of the Mindfulness Network.

About you

Title:
Forename:
Surname:
Address:
Town/City:
County:
Postcode:
Country:
Phone:
Email:

Please provide emergency contact details below:
Name of contact:
Relationship to you:
Phone number:

I am a Mindfulness Network Associate:

Your Mindfulness experience and practice

Completion of a mindfulness training programme over a minimum of 12 months, with a minimum of 10 full days of teacher training (or equivalent). Please provide name of programme, organisation and year of completion:

To have substantial experience over a minimum of three years in mindfulness-based work:
either
taught nine mindfulness-based programmes in recognised curricula (e.g. MBSR, MBCT, MBCT-L, Breathworks) or derivatives (e.g. Peace in a Frantic World, .b, .b Foundations)
and/or
taught/conveyed mindfulness in other ways e.g. shorter courses, introductory sessions, other innovations and one-to-one work.
Please provide details:

Please confirm familiarity with mindfulness inquiry process through training and experience: either an Inquiry Training course or incorporated into a training pathway (minimum 2 days or equivalent)

Please give dates/details:

Please confirm you have a regular mindfulness-based practice which includes some longer periods of practice, e.g. retreats

Please outline your practice, including retreats:

Please confirm you are engaged in ongoing professional development

Please provide examples from the last year:

Please confirm you have your teaching/mindfulness-based work observed and receive feedback from a mindfulness-based trainer, supervisor or mentor. Ideally, to have been competency assessed using a tool such as the MBI:TAC

Please provide details:

Please confirm you receive regular mindfulness-based supervision

Name of your supervisor/s (or equivalent):

Course fees

Please select the fee that you're paying

Is your employer or a company/organisation paying your fee?

Recognising the administrative overhead of dealing with employers, we will be adding a £50 surcharge if the employer is paying directly; where possible we would recommend that applicants pay themselves and reclaim on expenses to avoid the charge. Responsibility for payment remains with the attendee. Please note: If your employer is paying, a deposit option will not be available, and the full amount will be invoiced.

Please tick to confirm you have read the above information

Please provide further details of where to send your invoice: Organisation name:

Address for invoice to be sent:

Postcode:

Contact name:

Contact email address:

Contact phone number:

Do you have a purchase order number - if you are working within the NHS, this is usually necessary:

Additional information

Your physical and mental health

It is helpful for us to have some information about you so that we can best meet your needs at the event. Please provide information, if possible, to the following questions:

Do you have any physical illness or other limitation that may make hearing, sitting, or standing difficult?

Please provide further information:

Do you have any other specific learning needs?

Please provide further information:

Please provide any other information you would like to pass onto the admin team or teachers in connection with this application. Please include any dietary requirement needs, if applicable to this event

The Mindfulness Network

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Mindfulness-Based Supervision and Mentoring Training: Ongoing Learning and Development Workshop: Supporting Supervisees through Feedback and Guidance

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