Course Application (MBSRTT) Step 1 of 6 16% Please begin your application form by pressing the button below. Once you have advanced to the next page, you may come back and complete this form later. Your booking is NOT complete until we have reviewed your application form.HiddenUser First Name Name* First Last Address* Address 1 Address 2 Town/City County ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone*HiddenMobileHiddenWork PhoneEmail* HiddenWebsite if applicable Sector* Education Health & Social Care Criminal Justice Finance Hospitality & Leisure Retail Technology Organisation (if funded through employer)* Occupation or role related to your application* Relevant Work History*Education/CertificateCompletedLength of Training Formal Relevant Education, Qualifications and Trainings: We promote equality, inclusion and diversity so have flexible payment plans. Do you need to talk to us about ways to make the training more accessible to you?* Yes No If "yes" please give details below and indicate how we might be able to support your learningDetailsWhere did you initially find out about the course? Website Newsletter Email from MUK MUK Community Facebook LinkedIn Recommended/Word of mouth How do you intend to use your accreditation once you have completed the course?* Have You Completed an 8-week teacher-led Mindfulness-Based Introductory Programme eg MBSR/MBCT?* Yes No If yes, which course was it? Where? When? Name of Tutor/Online Course completion certificate*Max. file size: 125 MB.Please provide a certificate showing that you have completed the MBSR/MBCT(Please note that acceptance on the course is subject to you providing MindfulnessUK with your course-relevant certificate of attendance.) Tell us about your current mindfulness meditation practice, including both formal and informal practices* Do you have any logistical, health or practical requirements that may need support by MindfulnessUK? Please let us know these details on application via info@mindfulnessuk.com* Yes No (We find it helpful to know some details of your relevant health history so we can ensure safety for you and others, and to support your learning. Please let us know if there is anything we need to be made aware of to either by completing the section below or contacting us at MindfulnessUK.) Media consent*We occasionally like to celebrate your achievements on social media and in our newsletter. Do you consent to us using your name and picture in these communications? Yes No Declaration I have read and understand the Cancellation Terms and Conditions here. I understand that I am committing to the entire MindfulnessUK training programme, its tuition fees and the fee payable to the awarding body (where applicable) and that I am over 19 years old. I declare that all information contained within this application form is accurate.I have read and accept all the terms above* I accept Print Name Date Δ