Meditation Instructor Training for Clinicians Application Form - Fall 2024
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Submission Date *
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Email Address *
First and Last Name *
City *
State/Province *
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Time Zone *

What is your meditation practice currently? Please provide some detail, such as how often do you practice, for how long and what type of meditation do you practice?

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Have you taken any other courses in meditation or mindfulness? If so, please list the names and approximate dates here.
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The technique you will be learning is called Shamatha-Vipashyana. It is a practice done with eyes opened (rather than closed). Does this raise any questions for you?

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Please share in approximately 50-100 words (or more, if you like) what you hope to gain from this experience. It could be anything from “I simply want to deepen my own practice” to “I want to teach meditation as part of my clinical work.”

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How do you anticipate applying what you will learn in this program, as far as you know now?
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Note: Meditation is not for everyone. For example, for people with PTSD or a history of trauma, meditation may actually intensify suffering rather than relieve it. Please let me know any such medical or mental health history you would like me to be aware of.

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Please add anything else you would like me to know about you.

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Will you be using this course to obtain CPEUs from CDR?

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How did you hear about this course?

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Note: Attendance at all classes is mandatory. If necessary, one class may be missed, but it may not be class one or class nine. Please check the following. If I’m accepted, I certify that I can attend all of the classes below.

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Required

Note: Your full attention and participation is required at each class. If accepted, I will be able to give my full attention to the classes and check-ins (I will not be driving, walking, or otherwise engaged in a separate activity).

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Note: It is the student's responsibility to ensure adequate technology and bandwidth to attend all classes, even if traveling. I possess the technology and bandwidth to attend video teleclasses and agree to show up via webcam for each session.

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I agree not to teach others what I am learning in this program until it is completed, my own practice is stable, and I have successfully fulfilled all the requirements.

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