Exploring Mindful Leadership Application - Mindfulness in Schools Project

Please read each question carefully, and respond as fully and accurately as possible.

Please select the course you are applying for*
Full Name*
Email address*

Please check that this is entered correctly.
House number or name*
Street*
Town or city*
County or state*
Postcode*
Country*
Region*
Home telephone number (please include country code)*
Mobile telephone number (please include country code)*
Emergency Contact name and number whilst on the course:
Please give details of an emergency contact who will be available while you are on the course.
Emergency Contact Name*
Emergency Contact Landline No:*
Emergency Contact Mobile No:*
Your Employment:
Your Profession*
Name of Your Employer*
Postcode of Your Employer*
Is your employer*
- A maintained school (incl. grammar school) or academy chain in the UK
- An independent school in the UK
- A council, LEA or other governmental body
- A non-UK school or other international educational body
- Other (please specify)
- I am self-employed
Please specify*
Name of school or place of work:*
Postcode of school or place of work:*
Funding
How is your attendance being funded?
- Self-funded
- Other
Please provide the name and address of the organisation and the contact name and email address of the person we should send the invoice to:
Organisation name*
Organisation address*
Contact name*
Contact email address*

Please check you have entered the email address correctly.
Are you working, or aiming to work, in a middle or senior leadership role in a school or other educational setting?*
- Yes
- No
Which 8-week course did you complete?*
- .b Foundations
- .begin
- MBSR
- MBCT
- Breathworks
- MBLP
- MBLC
- Finding Peace in a Frantic World
- Mindfulness For Life
- MSC (8-week version only and must have read the Frantic World)
- The Present for Adults
Please specify the date you completed your 8-week course*
MM slash DD slash YYYY
8-week course Teacher Name*
Please confirm you are over 18 years of age*
- I confirm that I am over 18 years of age
Please confirm your level of English*
- I confirm that I am able to speak and understand English to an Upper Intermediate Level, i.e. I am able to interact fluently with native speakers, communicate effectively and understand everyday language without the aid of an interpreter.
Do you have any physical illness (including allergies) or other issues that may make sitting, standing, walking or doing simple mindfulness practices difficult for you? If yes, please tell us about it.*
- Yes
- No
Please explain*
There will periods during the Course when we engage in brief mindfulness practices. If there are any aspects of your life, e.g. recent mental health issues, trauma or major life events, that you feel may affect your participation in, or experience of, this Workshop please do let us know. Please be assured that any personal information you disclose will be treated in the strictest confidence.*
- Yes, there are personal mental health issues, trauma or major life events that are likely to affect my experience of this course.
- No, there are no personal mental health issues, trauma or major life events that are likely to affect my experience of this course.
- I am not sure.
Please explain*
Special Requirements e.g. any accessibility requirements or anything else you feel we need to know.
Read the MiSP Online Workshop Terms and Conditions
Please confirm that you have read our Terms & Conditions:*
- I have read, understand and fully agree to the Terms and Conditions and prerequisites for taking part in this training course and confirm that I meet these prerequisites.
Read the MiSP Privacy Policy
Please confirm that you have read our Privacy Policy:*
- I have read and agree to MiSP using my data for the purposes set out in the Privacy Notice
I understand it is my responsibility to:*
- Use the Zoom test call function to test my camera, microphone and sound prior to the course.
I understand it is my responsibility to:*
- Ensure I can attend the training from a room with a closed door where I will not be interrupted. If I have no alternative but to attend the course from my workplace, I will ensure that my colleagues understand that I will not be available for work-related tasks or responsibilities such as supervising students or attending meetings.
I understand it is my responsibility to:*
- Use a computer which is resting on a hard surface (rather than using a handheld device for the training).
I understand it is my responsibility to:*
- Keep my camera on for the duration of the training.
I understand it is my responsibility to:*
- Bring a commitment to learning and a willingness to participate in this training.
Where did you hear about this Course?*
- Your school
- Another organisation
- A friend
- A MiSP Leaflet
- A Facebook advert
- A MiSP event or stand
- Internet search
- MiSP on Facebook
- MiSP on Twitter
- MiSP on LinkedIn
- Other
Please state*
Please enter the search term used*
We’d love to stay in touch.*
- I’d like to be kept up to date with MiSP’s work, upcoming courses etc…..
- I’d prefer not to be contacted

Emergency Contact name and number whilst on the course:

Your Employment:

Funding