Introduction to Mindfulness Course Interest Form
Thank you for being interested in the 6-Week 60-Minute Online Mindfulness Course.

Teaching this course is integral to fulfilling my graduation requirements for certification as a meditation teacher.

As part of these requirements, there are a few tasks I'd like you to know (and complete later) as a potential course participant.
Sign in to Google to save your progress. Learn more
Email *
First things first, what's your name
 *
Which cohort of the course might work better for you? *
By enrolling in this donation-based meditation course, could you commit to attending each week to the best of your ability?

Consistent attendance from at least six participants is crucial for me to fulfill the requirements for graduation. Your commitment would be greatly appreciated. *
To meet the graduation requirements, I am required to record 10 minutes of meditation, 10 minutes of talk, and 10 minutes of Q&A from the live courses for my teacher to review.

Do you consent to being recorded (audio only)? *
Upon completion of the course, a short survey will be distributed. Can you fill out the survey, as it is a graduation requirement? *
What amount are you comfortable donating for the 6-week, 60-minute meditation course? Your contribution helps me continue offering these sessions to a wider audience. *
I'll donate a portion of the proceeds to give back. I'd love to hear your recommendations for organizations that you believe are making a positive impact. *
Let's keep in touch for future communication related to the course. Subscribe to my email list? *
Before we begin the meditation course, is there anything specific you would like to share regarding your well-being or any conditions I should be aware of to ensure your comfort and safety during our sessions?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms