Meditation and Facilitation Registration Form

Meditation and Facilitation for Mental Health CPD

Registration Form
The next steps ..

Welcome to the intake form for our 100-hour CPD accredited Meditation and Facilitation course. Please be aware that all of the information you provide below will be encrypted and securely stored. Contact us if you have any questions or concerns about how we store and protect your personal data in accordance with UK GDPR and ICO guidelines. Email shaura@thepcip.org if you have any questions.
Cohort Start Date*

20242025

Student Information

Please be aware that all of the information you provide below will be encrypted and securely stored. Please contact us if you have any questions or concerns about how we store and protect your personal data in accordance with UK GDPR and ICO guidelines.
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number
Contact Preferences*

EmailTelephoneSMS/Text

Background & Personal History

The following questions are intended to help us understand more about your background and relevant personal history. Your responses help to inform us of how we might best be able to support your journey through our course.
Have you ever trained in a helping tradition before?*

YesNoUnsure
What is your current job role?*
Please describe any previous training that may be relevant to your application...*
Have you been diagnosed with a mental health or neurodevelopmental condition?*
Is there anything else in your background or personal history you would like to share?
How does it feel to be you at this time?*

Starting Point

Please take some time to reflect on your starting point, you can save your progress and return to the form later if you need time to sit with your thoughts. We want to know where you are in life, and what are you bringing to the cohort.
Why do you feel drawn to this CPD?*
What are you most looking forward to on this course?*
Do you have any concerns about the course or wish to tell us of any specific needs you may have?*

Intake Forms & Course Fees
Are you are prepared to pay the £400 holding deposit to secure your place on the course?*

YesNot Sure
Would you like to be contacted to discuss payment plan options for the remainder of the course fees?*

YesNo
Upload Signed Student Contract (Required) *

Browse Files

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Upload Signed Course Policy (Required)*

Browse Files

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Certify & Submit
Applicant's Name*

First NameMiddle NameLast Name
By signing below, I certify that the information I have provided above is true to the best of my knowledge without any malice, negligence, or any intent to commit acts of misrepresentation. I am also aware that any intentionally false, misleading, or deceptive information provided may result in the automatic refusal of my application or subsequent withdrawal from the course, without recourse to a refund of monies paid towards my course fees.
Signature
Date Signed*

MonthDayYear
Date
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Meditation and Facilitation for Mental Health CPD