ACMM Application for Enrolment - 'Certificate/Advanced Certificate in Guiding and Teaching Meditation’ Australian Centre for Meditation and Mindfulness

Enrolment Form for Certificate Courses at The Australian Centre for Meditation and Mindfulness
Name *

First Name Last Name
Do you go by any other name? (Maiden/nick name)
Occupation *
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Postal Country
Phone (Mobile) *

Area Code Phone Number
Phone (Home) *

Area Code Phone Number
Age *

18-25yrs 26-30yrs 31-35yrs 36-40yrs 41-45yrs 46-50yrs 51-55yrs 56-60yrs 61-65yrs 66-70yrs 71-80yrs
Which course are you enroling in? *

Meditation for well being (for personal devt & family) Certificate in Guiding and Teaching Meditation (professional qualification) Advanced Certificate in Guiding and Teaching Meditation (professional qualification) with 3 electives Advanced Certificate with 6 electives
If you are enrolling in the Advanced Certificate would you like to enrol in any Advanced Certificate Streams? (If you don't feel ready to make this choice now you can just enrol in the general Advanced Certificate and decide later.)

No I would like to stay with the general Adv Cert for now Yes- Workplace Meditation and Mindfulness Yes- Community and Support Groups Yes- Mental Health and Wellbeing Yes- Spiritual Meditation Yes- Meditation for Women
Have you already purchased any electives? *

No I haven't (you don't need to have completed any to enrol) Journalling for Clarity Meditation and the Chakras Bringing Mindfulness Home
If you are enrolling in the Advanced Certificates and you have already completed one or more electives would you like the cost of these electives to be deducted from your course fees?

Yes, please deduct the cost from my final payment/s on my payment plan or my upfront amount No, I want to complete the extra electives, so I will pay the full amount
You have the option of adding electives to your course if you wish to at any stage of your studies or after graduation in addition to those already included in your course package.

You don't have to decide which electives you will complete right now.

Please note your packages include:

- Certificate (no electives)

- Advanced Certificate with 3 electives

- Advanced Certificate with 6 electives
Did you hear about this course from another student /graduate or staff member at ACMM? *

No, it was through my own research Yes, (please give name and surname of person who referred you or the Coupon Code supplied to you)
Name
Have you completed any previous training in meditation? *
What do you intend to do with this qualification? *
When would you like to begin this course? *

Now or At a later time (within 6 months)
Proposed start date
Please indicate your preferred time for coaching calls from the following options, by ticking 2 boxes. (Please note time frames are in Australian Eastern Standard Time). Available times change from time to time. Morning times start at 9.30am. *

Monday morning FULL Monday afternoon FULL Monday evening Tuesday morning Tuesday afternoon Tuesday evening Wednesday morning Wednesday afternoon Wednesday evening Thursday morning Thursday afternoon Thursday evening Friday morning Friday afternoon FULL Friday evening FULL Saturday morning Full
Please upload a photo of yourself to share with your coach only.

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Please provide an emergency contact - Name and phone number. *
Payment Details
PAYMENT METHOD. There are 2 payment methods: Upfront or Payment Plan. Please refer to the current Course Prospectus for the upfront amounts and payment plans available.

Students in Australia:

If you are paying Upfront and by Internet Transfer, please see ACMM banking details on this form (below) for your transfer.

If you are paying by Payment Plan, you will need to fill out your payment plan choice below. We will use the details provided on this form to set up an Ezidebit account for you. Following that (in the next 24 hrs) you will receive an email from EZIDEBIT providing you with a secure link to register your credit card or bank direct debit information. Please check your SPAM folder for this email if you don't see it.

Please note: For all Payment Plans and upfront Credit Card payments, a $5.50 once only client set up fee is charged by our payment provider (Ezidebit) along with a $0.99 per transaction fee for bank accounts and 1.87% of the transaction for Visa and M/Card.
* A dishonour fee of $21.90 is charged where there are insufficient funds (by Ezidebit)

International Students:

Please visit our International Student's Payment Page to pay Upfront or by Payment Plan using PAYPAL.
Chosen Payment Method *

Upfront by Internet Transfer Upfront by Credit Card Payment Plan
I would like to apply for a Concession Rate (5 % discount) available on payment plans and on Certificate courses only. Please upload a photo of your concession card.

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Do you have a Coupon Code, please enter here:
If you are paying UPFRONT and by Internet Transfer

Please take note of our bank details for your transfer.

Account Name: ACMM Trust ATF ACMM Pty Ltd

BSB: 063 151

Account Number: 1065 9320

Please enter your name as our reference.

Your enrolment will be complete once payment has been received.
I am paying by internet transfer and will deposit funds into ACMM account
Amount to pay
If you are paying by PAYMENT PLAN

Please enter your payment plan choice.

Regular amount: Eg. $133

Number of payments: Eg. 20

Payment frequency: Monthly/F-nightly.
Regular amount
Number of payments
Payment frequency - Mthly / f-nightly
Date that payments can begin. Please note you will be able to begin the course only once your first payment has been successfully processed.

Day Month Year
Date
If you are paying monthly, your payments will be deducted around this date, allowing for weekends/public holidays.

By entering into this agreement you agree to receive SMS payment reminders the day before your payment is due to be deducted.

Please note there are additional charges (made by Ezidebit) for dishonoured payments.

As stated above, you will receive a secure payment link by email from Ezidebit for your payment source details.

Alternatively, you can phone your details to our office on 03-9807 4889.
Payment agreement (Please tick all boxes unless you are paying by internet transfer or PAYPAL)

I agree with the Ezidebit Service Agreement. Ezidebit Service Agreement. I agree to ACMM providing only relevant information on this form to the secure payment provider Ezidebit Pty Ltd.
Ezidebit Service Agreement.
The questions below allow us to ascertain whether you may need additional support throughout the course, and to ascertain whether the course will be suitable for you.
Have you been diagnosed with a mental illness or do you have an undiagnosed mental health condition? eg. Bipolar, depression, anxiety, post-natal depression, suicidal tendencies, self harm tendencies etc. *

Yes No
If yes, please detail below. Please specify if you currently have severe depression or any form of psychosis.
Are you addicted to any mood altering substance? Eg. Alcohol, marijuana or other drugs where I have become dependent on their usage. *

Yes No
If yes, please detail below
Are you taking any mood altering medication? *

Yes No
If yes, please detail below
Are you currently receiving medical/psychiatric/psychological support? *

Yes No
If yes, please describe the kind of support.
Is there anything else that you would like us to know that will help us support your learning experience? E.g. dyslexia, chronic fatigue etc or anything else.
Training Agreement Australian Centre for Meditation and Mindfulness
Agreement between

AUSTRALIAN CENTRE FOR MEDITATION AND MINDFULNESS (ACMM) and Student (as mentioned on above enrolment form).
- I am over 18 years of age.
- I understand that some aspects of my Learning Journey may be shared by the trainer in professional supervision sessions with a training supervisor for professional development purposes only.
- I am assured that the information I provide on this form is kept by ACMM in accordance with the Health Privacy Act relevant to the country and state in which this training occurs.
- I understand that all materials supplied to me and processes contained within the course are copyright and remain the property of ACMM.
- This course does not accredit or train me to run Meditation Teacher Training courses.
- I take full responsibility for any additional support I personally may require. I can do this by booking in with a practitioner of my own choosing either from ACMM or elsewhere and making use of the processes provided to me for my own home support.
- I understand that I have 30 days from date of enrolment in which to confirm that the course meets my expectations. After this time no refunds will be issued. Please note that if you are a delayed starter, as the 30 days starts from your commencement date, not enrolment date.
- This course is designed for responsible and healthy adults and is for educational purposes only. It does not replace counselling, psychiatric or medical support. Participation is voluntary and proceeding to undertake this programme is an indication that you agree to take responsibility for your wellbeing.
*

I have read and agree to the above Training Agreement
*

I have read and agree to comply with the ACMM Policies & Procedures
Policies and Procedures
In our courses you will be meditating more intensively. As you do this there are some common things that happen:

1. You will get more in touch with what's going on for you (your bodily sensations, deeper thoughts and emotions).
2. You may get in touch with things that you have not noticed for a while, or that you may have been avoiding. This can sometimes feel uncomfortable.

Less commonly, If you are in an acute stage of depression, anxiety or trauma or have had psychosis then we recommend that you be consulting, and under the close supervision of a qualified mental health professional.

If this is a time when you are feeling severely affected then this may not be the right time to begin this course of study. We suggest that you seek professional mental health support and advice before doing so.

If after consultation with a mental health professional you have decided to move forward with studying meditation with ACMM, It may be wise to proceed slowly, taking in a bit at a time. You may like to try our 21 day program (available in our website shop) or the Meditation and the Chakras Elective. These are stand alone short courses and that lead into our Certificate courses. Completing these short courses can be a good introduction to the nature of this work and give you a taste of what to expect as well as helping you find out whether this is the right timing for you, without the pressure of assessments and deadlines.

If anything uncomfortable happens that becomes persistent whilst you are meditating or afterwards, ask an experienced meditation teacher such as your coach or a meditation teacher with mental health experience.

In order to manage this course well you will need to be:

- Feeling calm, clear, connected and safe.
- Able to be aware of the present moment with an ability to think clearly, self-soothe and regulate emotions.
- Able to tolerate and cope with a range of emotional and physiological activation e.g. stress, pressure and discomfort.

- Out of active addiction.

We are here to support your wellbeing and an optimal study experience. If you are unsure whether this course is right for you please call Lisa on 03-9807 4889 for an informal chat.
*

I have read and understand this advice.
Date

Day Month Year
Date
WHAT HAPPENS NOW?

Once you click SUBMIT on your enrolment form you will hear from us by the end of the next working day. Please check the email address that you have placed on your enrolment form. (Please also check your SPAM folder)

In the next 24-48 hrs you will receive a Welcome email that contains administration information, your receipt or payment schedule etc.

You will also receive an email from your coach inviting you to book a SET UP call. (This is a one on one introductory call with your coach on Zoom in which you will learn all about how the course works before you begin, set some goals and set a date for your first submission). Immediately after that call you will receive Session 1.

If you do not receive any emails from us in the next 24 hrs and you have checked your SPAM folder, please email admin@meditationandmindfulness.com.au or call 03-9807 4889.

We are looking forward to welcoming you to the ACMM Community!
Lisa Forde and the ACMM team
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Enrolment Form for Certificate Courses at The Australian Centre for Meditation and Mindfulness

Payment Details

The questions below allow us to ascertain whether you may need additional support throughout the course, and to ascertain whether the course will be suitable for you.

Training Agreement Australian Centre for Meditation and Mindfulness