Fall 2020 - Focused Falcon Mindfulness Workshop Registration
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First Name
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Last Name
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Status
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Please Select
Faculty
Classified Staff
Administrative Staff
Graduate Student
Undergraduate Student
Which workshop would you like to participate in:
Sept 18 - Oct 9: Fridays from 1 -1:50 PM
Oct 19 - Nov 9: Mondays from 11 - 11:50 AM
How would you like to receive your materials:
On-campus pick-up
Please mail to the address below
Address that you would like your materials shipped to:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pre-Program Information
How would you describe your level of experience with mindfulness?
No prior experience
Have tried it before, but currently don't practice
Practice it occasionally
Practice it frequently
I am able to notice quickly when my mind wanders and quickly bring my attention back to the present moment
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
On average, how many days per week do you engage in at least 30 minutes of physical activity?
Please Select
0-1 days per week
2-3 days per week
4-5 days per week
6-7 days per week
In an average week, how often have you been bothered by any of the following problems:
Not at all
Several Days
More than half the days
Nearly every day
Feeling overwhelmed by all you have to do
Feeling exhausted (not by physical activity)
Feeling overwhelming anxiety
Trouble relaxing
Becoming easily annoyed or irritable
Feeling down or bad about yourself
Trouble concentrating on things such as school work or work tasks
Do you believe the practice of mindfulness is beneficial to your overall well-being?
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
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