Apply for supervision



Below is an application form to apply for supervision. Before completing it, please read our guidance on supervision, frequently asked questions, and choose a supervisor. Please complete the form with as much detail as possible to enable the supervisor to quickly process your application.

The Mindfulness Network Supervision registration fee is payable at point of application and covers the admin costs of routing your application to a supervisor and contributes to the supervision advisory service. Once you have completed the form, you will be taken to a payment screen where we ask for your £25.00+VAT registration fee. If we are unable to match you with a supervisor, your fee will be returned to you.

Please contact the team via info@mindfulness-network.org if you have any queries.


About you

Title:

Forename:

Surname :

Profession/area of work:

Address 1:

Address 2:

Address 3:

County:

Postcode:

Country (if not UK):

Telephone:

Email:

Date of Birth:

Employer / payer details

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.

Your supervision

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:
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?

Previous experience

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?