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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.
Hidden
User First Name
Name
*
Your full name as declared on ID, this is the name which will be on your official Certificate on passing the course.
Title
Dr
Miss
Mr
Mrs
Ms
Prof.
First Name
Last Name
Date of birth
*
DD slash MM slash YYYY
Preferred Name
What you would like us to call you
Gender Identity
*
(hover for dropdown selection) CPCAB requirement
Female/She/Her
Male/He/Him
Prefer not to say
Non-Binary
Address
*
Address
Address2
Town
County
Postcode/ZipCode
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Phone
Second Phone
Hidden
Work Phone HIDDEN AS NOT IN USE
Email
*
the email you booked with
Sector
*
Education
Health & Social Care
Criminal Justice
Finance
Hospitality & Leisure
Retail
Technology
Organisation (If funded through employer)
*
Occupation or role related to your application
*
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
Please provide details
Work and Qualification History
Level 3 or above qualifications required in any subject
List
*
Place of work
Dates
Qualification/Training Details (level 3+ or relevant to this qualification)
Certificate (Must be level 3 certificate or above)
*
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 125 MB.
Please upload any certificates of relevant work or training (max file size 19.5MB)
Where 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
Which course was it?
*
MBSR (8 week)
MBCT
CMR
Other (self taught)
Where?
*
When?
*
Name of Tutor/Online (if self taught put yourself)
*
Do you have a personal regular Mindfulness meditation practice that you have sustained for 6 months or longer?
*
Yes
No
Tell us about your current mindfulness meditation practice, including both formal and informal practices
*
Learner Photo ID: please scan a copy and upload (One form of ID required)
ID Type
*
Passport
Driving Licence
Passport/Drivers Licence Number
*
ID Upload
*
Accepted file types: jpg, gif, png, pdf, Max. file size: 125 MB.
Please upload your identification - PASSPORT or DRIVING LICENCE ONLY please (max file size 19.5MB)
Equal Opportunities: Disability
Health & Disabilities
*
Do you have any disability, health or practical requirements that may need support by MindfulnessUK?
Please let us know these details on application via info@mindfulnessuk.com (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.)
Yes
No
Nature of disability / requirement
Hearing
Learning
Visual
Mobility
Other
Please provide details
Equal Opportunities: Ethnicity
I would describe my ethnic origin as
*
White British (WB)
White Irish (WI)
White (Other) (OW)
Mixed White and Black Caribbean (MC)(British or otherwise)
Mixed White and Black African (MB)(British or otherwise)
Mixed White and Asian (MA)(British or otherwise)
Mixed Background (MO)(British or otherwise)
Asian or Asian British Indian (AI)
Asian or Asian British Pakistani (AP)
Asian or Asian British Bangladeshi (AB)
Other Asian (OA)(British or otherwise)
Black or Black British Caribbean (BC)
Black or Black British African (BA)
Other Black background (OB) (British or otherwise)
Chinese (CH)(British or otherwise)
White European
White Non-European
Other (OT) (British or otherwise)
Prefer not to say
Hover for dropdown (CPCAB req)
Do you have any logistical, health or practical requirements that may need support by MindfulnessUK?
Media use 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? Thank you.
Yes
No
Declaration
I have read and understand the
Cancellation Terms and Conditions
. 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
By ticking this box you confirm that you have read and accept the financial obligations, terms and cancellation policies specific to your course, which are detailed above.
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Date
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