SPFT staff application form for 8-week SMC mindfulness course

SPFT staff application form for eight-week mindfulness courses

All courses are online and are nine weeks in total, including the orientation session. Please find the list of course options to choose from at the bottom of the form.
To help us support you as best we can, please complete the following questions. Most fields are mandatory - please do leave as much detail as you can and state if you would like to arrange to speak with the course facilitator privately if preferred. The form will remain confidential to the course organiser and facilitator.

All enquiries to spft.smc@nhs.net
- Application form name
  This information is for reference only
- Full name
  
  First NameLast Name
- Job title
- Correspondence address
  
  Street Address
  
  Street Address Line 2
  
  CityCounty
  
  Post CodeCountry
- Email
  example@example.com
- Please add a second work or personal email if you'd like course information sent to both addresses:
  example@example.com
- Mobile number
  Example 07770 123456Format: 00000-000000.
- How should we contact you if you do not attend a course session? Please give a number and/or email. (Please note, you may not be at work if sick, for example.)
- Please tick the box to confirm that you have approval from your manager to attend this mindfulness course. (Your manager will be sent an automatic email informing them that you have submitted this application.)
- The course is free to attend. However, please confirm you are aware that your department may be charged the course fee of £250 if you miss more than two of the eight main sessions, or do not attend/drop out before the course ends. Bank staff would be personally liable to cover the cost.
- It's important to understand the level of commitment required when embarking on this course. Please watch this video to find out what the course involves and hear from previous participants. If you are still committed after this, please continue with your application.
- Manager's name
- Manager's job title
- Manager's email
  example@example.com
- Are you attending this course in work time?
- Have been recommended to attend by an Occupational Health Adviser?
- So we can understand how to best let people know about our work, please tell us where you heard about this training. Please tick all that apply.
  
  Other
- Why do you want to attend this course?
- Have you attended any Trust 8-week Mindfulness groups before? If so, when? And who was your teacher?
- The course involves attending eight two-hour group sessions (and an initial orientation session) and suggested home practice of between 20-40 minutes a day between sessions. Having checked all the dates and times of your preferred courses (listed below), can you foresee any difficulties that you may have with doing this?
- If ‘yes’, please explain
- The mindfulness course does ask people to make gentle movements. These can usually be adapted to meet people’s needs. If you have any physical mobility concerns or queries please provide details below.
- If you have any additional needs or learning styles that would support your inclusion in this course, please could you let us know below.
- Have you done any meditation or yoga/Chi Gung before?
- If ‘yes’, please provide brief details of what you have done, whether you currently practice and how long you have been practicing for?
- Is there anything else it would be helpful for us to know that might affect how you get on in the group sessions? (For example, it would be important to mention any mental health issues, any recent, significant stress or life events, and any concerns you might have about being in a group). Even if you do not provide full detail here, it is important that you make the facilitator aware if these issues exist so they can support you should they manifest in the process of doing the group sessions.
- In order to support their continuing professional development and ongoing professional registration, the group facilitator may wish to record some sessions of the mindfulness group. These recordings would be stored securely, only shared with the facilitator's supervisor and deleted after use in supervision. Please confirm whether you are in principle happy for this to occur (if all participants are in principle happy with this then we'll ask everyone to complete a more detailed consent to recording form).
- Are you interested in going on to train to teach mindfulness with us?
- Would you like to be added to the Sussex Mindfulness Centre email list to stay aware of our future events, groups and training? (We will not pass your details on to anyone else outside of SMC.)
- Please let us know which group(s) you can attend by placing them in the right column in order of preference, from top to bottom. (Simply click on your chosen groups to move them back and forth between the columns.) Places are limited, so please select all possible options, putting them in order of preference with your first choice at the top:
- Should be Empty:

SPFT staff application form for eight-week mindfulness courses