MBCT / MBSR Certification Request Form

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The Centre for Mindfulness Studies will issue a certificate to Certified MBCT Facilitators and Certified MBSR Facilitators once trainees have completed the required training modules in Step 4 as described at https://www.mindfulnessstudies.com/pro-dev/mbct-cert/ and https://www.mindfulnessstudies.com/pro-dev/mbsr-cert/

Please note that the letter of recommendation from an approved mentor must be received for certification to be confirmed.

Email *

First Name *

Last Name *

Your Name (exactly as it should appear on the certificate) *

Please note that CMS will not include professional designations or credentials on facilitation certificates.

Which training pathway have you completed? *

If you have completed both training pathways, please submit two separate request forms.

Certified MBCT Facilitator

Certified MBSR Facilitator

Please indicate when you completed the Advanced training modules

Advanced Teacher Training Intensive *

In what month and year did you complete the ATTI?

YYYY

Advanced Mentorship *

In what month and year was your letter of recommendation signed?

YYYY

Approved Mentor *

Which Centre-approved mentor wrote your letter of recommendation?

5-7 Days of Silent Retreat (can be a combination of retreats), please list the details of each retreat; dates, facilitator, centre, etc.
*

Send me a copy of my responses.

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