Purchase Order Interest Form

Thank you for supporting Mindful Schools!

Please fill out this form at least three (3) days prior to the course registration deadline. You may enter up to 9 participants on a single form. Please have your signed PO ready to attach to the end of the form. You will need:

Participant information
Billing contact information
A signed purchase order with billing contact information made out to:

Mindful Schools, 1260 45th Street, Emeryville, CA 94608

When this information is received, we will process the registration and send confirmation within 3-5 business days. Our Accounting team will follow up with an invoice to complete the payment process. Please be sure to submit purchase orders at least three days before the registration deadline.

If you are registering a group of 10 or more participants, click here to learn more about our group enrollments and connect with our School Support team.

If you have any questions, feel free to contact us at support@mindfulschools.org.

Billing Contact Email Address *

example@example.com

How many participants are you registering with this PO? *

Which course(s) is this PO for?

101: Mindfulness Foundations 201: Mindfulness in the Classroom School Implementation Clinic Self-Compassion for Educators Mindful Communication

What month will the chosen 101: Mindfulness Foundation session start? *

What month will the chosen 201: Mindfulness in the Classroom session start? *

What month will the chosen Self-Compassion for Educators session start? *

What month will the chosen Mindful Communication session start? *

Prerequisite Confirmation for 201: Mindfulness in the Classroom *

Check this box to confirm that the participant(s) have taken 101: Mindfulness Foundation

Prerequisite Confirmation for 301: School Implementation Clinic *

Check this box to confirm that the participant(s) have taken 201: Mindfulness in the Classroom

Participant Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Participant 2 Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Participant 3 Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Participant 4 Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Participant 5 Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Participant 6 Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Participant 7 Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Participant 8 Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Participant 9 Name *

First Name Last Name

Participant Email *

example@example.com

Participant Profession *

Billing Contact Name *

First Name Last Name

Billing Contact Organization Name *

Name of School, District etc...

Billing Contact Email *

example@example.com

Billing Contact Phone Number *

ex. 510-555-2222 (no parentheses)

Billing Street Address *

Billing City *

Billing State *

Billing Zip Code *

Additional Comments

Upload signed Purchase Order

Browse Files

Must include a signature and billing contact information. Please include billing organization and PO# in file name.

Due Date

Date