Below is an application form to apply for supervision. Please complete the form with as much detail as possible to enable the supervisor to quickly process your application.

The Mindfulness Network registration fee is payable at point of application and covers the admin costs of routing your application to a supervisor and contributes to the supervision advisory service. Once you have completed the form you will be taken to a payment screen where we ask for your £25.00+VAT registration fee.

Please contact the team via info@mindfulness-network.org if you have any queries.

About you

Title: Forename: Surname:

Profession/area of work:

Address 1:

Address 2:

Address 3:

County:

Postcode:

Country (if not UK):

Telephone:

Email:

DOB:

Will you personally, or will your employer be paying your supervision fees?

Please provide the name of your employer:

Please provide the address of your employer:

Please provide an e-mail address for invoices to be sent to:

Purchase Order Number/other information required by your employer:
Please note that this information will appear on each invoice sent to your employer.

Your supervision

Additional details (e.g. reason why supervisor chosen / area of expertise):

Please select your supervisors, if this supervisor is unable to offer supervision you will be sent details on how to select another supervisor:
Nomination:

When would you like to begin supervision?

How frequently would you like to have supervision?

For what length of time?

Method?

Will you be using videotape?

What are you hoping for from supervision?

Previous experience

Please outline any training you have in mindfulness-based approaches (MBA):

Please outline any experience you have of teaching MBA:

Please outline your personal mindfulness practice:

How does MBA teaching fit in to your current working context?