New MBCPTT Scholarship Application

MBCP Teacher Training (MBCPTT) Scholarship Application Form
At the Mindful Birthing and Parenting Foundation, we recognize that financial challenges can make it difficult for some individuals to access MBCP Teacher Training. To help, we offer scholarships to those from strategically underserved or marginalized communities, as well as those experiencing financial hardship. Each application is carefully reviewed on a case-by-case basis.
MBCP Teacher Training Series
Please select the class series you wish to apply for from the drop down
Which level(s) are you applying for scholarship for?
Application Information
Name*

First NameLast Name
Pronouns*

She/HerHe/HimThey/ThemOther
Email*
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Profession (you can choose more than one)*

MidwifeOB/GYNNurseChildbirth EducatorMedical DoctorDoulaCounselorLecturer / ProfessorMindfulness TeacherNutritionistPsychiatristPsychologistPublic HealthResearcherSocial WorkTherapistYoga TeacherOther
How did you learn about MBCP? (e.g., word of mouth, advertisement, professional workshop, mailing, reading Mindful Birthing)*

Word of mouthFacebookInstagramProfessional workshopMindful Birthing bookNews articleInternet researchMindful Birthing emailFriend recommendationProfessional recommendationMBCPTT AlumniOther
Please provide the name of the Alumni who referred you below.
Current employer?*
What is your primary language?*
In what language do you intend to teach?*
If you speak other languages that you would be willing to use in practice with a classmate, please list them here.*
Have you completed an MBSR, MBCT, or MBCP course?*

YesNo
Please give date, location, sponsoring institution, and instructor's name for the MBSR or MBCT course you have attended
Have you completed any MBSR or MBCT Professional Trainings?*

YesNo
Please provide details of the MBSR or MBCT Professional Trainings you have attended?
Do you have a regular meditation practice?*

YesNo
Please provide details of your regular meditation practice
Have you completed a 5-10 day silent retreat?*

YesNo
Please provide details of the 5-10 day silent retreat(s) you have attended
Do you work with birthing families in or outside of a hospital setting "perinatal health experience"?*

YesNo
Please provide details of the perinatal health experience you have
Have you attended women during childbirth?*

YesNo
Please provide details of how many births in the last 3 years?
Are you currently or have you recently found yourself struggling with issues relating to your own birthing history. (We may ask you more about your answers in order to be sure that this is the right time for you to do this training)*

YesNo
Are you currently seeing a therapist or psychiatrist?*

YesNo
Do you have any teaching or group facilitation experience?*

YesNo
Please provide details of your teaching or group facilitation experience?Please provide details of how many births in the last 3 years?
Have you attended any MBCP Trainings?*

YesNo

If Other, please provide details of the training and the date
Do you want to tell us anything else about your meditation practice, perinatal training, or experience?*
What are your intentions for integrating this training into your life or work?*
Are you also applying for ACNM CE Credits?*

YesNo
Scholarship Information
Financial Information
Are you a perinatal professional working in Massachusetts with under-served or under-resourced communities?*

YesNo
What is your current total annual household income (before taxes)? Please select the appropriate income range*

Less than $20,000$20,000 – $49,999$80,000 – $109,999$110,000 – $149,999$150,000 or more

Please select the option that best describes your level of disposable income at the end of each month*

	Considerable	Moderate	Minimal	None
Disposable Income at the end of the month

What is your financial need?

You can afford to attend the program without a scholarshipYou can afford to attend the program without a scholarship but it would cause financial hardshipYou cannot attend the program without a scholarship
*Please be aware that there is a minimum $450 co-pay for all scholarships (including full scholarships) to cover mentoring costs.

Note: Standard Tuition Fees: $4,750
(currency converter: https://www.xe.com/currencyconverter/)
How much of the course fee are you able to contribute towards (see below for payment plans?

I can contribute 75% of the program fee - payment = $3,562.50I can contribute 50% of the program fee - payment = $2,375.00I can contribute 25% of the program fee - payment = $1,187.50I can only contribute the $450 copay - payment = $450.00
If you are awarded a scholarship, will you also require a payment plan to spread the payment of the outstanding amount?

YesNo
Community and Identity Information
Which of the following applies to you?
1. Do you identify as a member of a marginalized or underrepresented group? (you may choose more than one)*

Rural familiesGlobal Majority families (Black, Indigenous, People of Color)Unhoused familiesMilitary familiesTwo spirit, lesbian, gay, bisexual, trans, queer/questioning, intersexed, asexual (LGBTQIA+)Recent immigrant familiesFamilies affected by substance useInternally displaced familiesOther (please specify below)
2. Are you living in an underserved community or under-resourced community? (you may choose more than one)*

I live in an economically disadvantaged areaI live in a rural or remote area with limited access to servicesI live in an area with limited access to quality educational opportunitiesI live in an area with limited access to healthcareI live in a low-income householdNone of the aboveOther (please specify below)
3. Do you serve members of an under-served or under-resourced community? (you may choose more than one)*

Rural familiesGlobal Majority families (Black, Indigenous, People of Color)Unhoused familiesMilitary familiesTwo spirit, lesbian, gay, bisexual, trans, queer/questioning, intersexed, asexual (LGBTQIA+)Recent immigrant familiesFamilies affected by substance useInternally displaced familiesOther (please specify below)
4. I serve members of high-risk perinatal populations with poor birth outcomes*

YesNo
5. I live in an area without access to mindfulness-based providers (MBCP, MBSR, MBCT)*

YesNo
What is the likelihood that you will teach MBCP upon completion of the MBCPTT program? (where 1 is unlikely and 5 is very likely)*

1

2

3

4

5

1 is Worst, 5 is Best
What is the likelihood that you will conduct research upon completion of the MBCPTT program? (where 1 is unlikely and 5 is very likely)*

1

2

3

4

5

1 is Worst, 5 is Best
What is the likelihood that you will make MBCP a central focus of your perinatal practice? (where 1 is unlikely and 5 is very likely)*

1

2

3

4

5

1 is Worst, 5 is Best
Have you explored other modes of funding your MBCPTT enrollment? (i.e., crowdfunding, work or community sponsorship, grants)?*

YesNoNo, but I plan toOther
What is the likelihood that you will be able to enroll in the MBCPTT program without *full* scholarship support? (where 1 is unlikely and 5 is very likely)*

1

2

3

4

5

1 is Worst, 5 is Best
What is the likelihood that you will be able to enroll in the MBCPTT program without *partial* scholarship support? (where 1 is unlikely and 5 is very likely)*

1

2

3

4

5

1 is Worst, 5 is Best
What is the likelihood that you will be able to enroll in the MBCPTT program paying the full tuition using a low-interest extended payment plan? (where 1 is unlikely and 5 is very likely)*

1

2

3

4

5

1 is Worst, 5 is Best
Please provide any additional information that may assist with your scholarship application
Should be Empty:

	Attended	Date	Location	Instructor
Introductory Retreat
9 Week MBCP Course
MBCP Intensive Workshop
Other

MBCP Teacher Training (MBCPTT) Scholarship Application Form

MBCP Teacher Training Series

Application Information

Scholarship Information

Financial Information

Community and Identity Information