MBSR Facilitation Certificate Request Form

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The Centre for Mindfulness Studies will issue an MBSR Facilitation Certificate to trainees who have completed the required training modules in Steps 1, 2, 3 as described at https://www.mindfulnessstudies.com/pro-dev/mbsr-cert/.

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.

Please indicate when you completed the MBSR training modules listed below (approximate dates are fine)

Mindfulness Core Concepts *

YYYY

MBSR Teacher Training Intensive *

YYYY

MBSR Practicum *

Please enter the date when you completed the MBSR Practicum or make a note that you completed 2 x mentorship. Note that this second option is only applicable to trainees who completed the MBSR TTI in 2021 or earlier.

MBSR Mentorship *

YYYY

Approved Mentor *

Which Centre-approved mentor submitted your Mentorship Completion Form?

Inquiry Essentials *

YYYY

Send me a copy of my responses.

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