Below is an application form to apply for individual supervision or supra-vision (if you are interested in group supervision please contact supervision@mindfulness-network.org). Before completing it, please read our frequently asked questions and choose a supervisor. Complete the form with as much detail as possible to enable the supervisor to quickly process your application.
Please contact the team via supervision@mindfulness-network.org if you have any queries.
Title:
Forename:
Surname :
Profession/area of work:
Address 1:
Address 2:
Address 3:
County:
Postcode:
Country (if not UK):
Telephone:
Email:
Date of Birth:
Will you personally or will your employer be paying your supervision fees?
If your employer is paying then please provide …
The name of your employer:
The address of your employer:
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.
Additional details (e.g. reason why supervisor chosen / area of expertise):
Please select your supervisor; if this supervisor is unable to offer supervision you will be sent details on how to select another supervisor:
First nomination:
Second 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?
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 into your current working context?
