Courses - Bursary Request Form

Breathworks Courses: Bursary Request
Full Name*

First NameLast Name
Address*

Street Address

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CityState / Province

Postal / Zip CodeCountry
Date of birth*

DayMonthYear
Date
E-mail*
example@example.com
Phone number*
Which course do you want to attend?*

Online Mindfulness for HealthOnline Mindfulness for StressOnline HEALS course
Which Online Mindfulness for Health course date you would like to attend (if possible, please choose more than one)?*
Date unavailable? Click here to join the waitlist
You can still be added to a waiting list. Please let us know which one you would like to get contacted in case we have a place available*

OMfH 6 Jan, Monday, 6pmOMfH 14 Jan, Tuesday, 2pmOMfH 1 Feb, Saturday, 10amOMfH 5 March, Wednesday, 6pmOMfH, 3rd April , Thursdays, 2pmOMfH, 6th May, Tuesdays, 10amOMfH, 6th June, Friday, 2pmOMfH, 7th July, Monday, 6pmOMfH, 5th August, Tuesday, 2pmOMfH, 6th Sept, Saturday, 10amOMfH, 1st Oct, Wednesday, 6pm
Note that if you are attending a Mindfulness for Health group course, that you will also need to buy the course handbook which costs approx. £14. Please bear this in mind when saying how much you can afford to pay for the course.

The book can be purchased separately in the Amazon or Waterstones shop.
Which Online Mindfulness for Stress course date you would like to attend (if possible, please choose more than one)?*
Date unavailable? Click here to join the waitlist
You can still be added to a waiting list. Please let us know which one you would like to get contacted in case we have a place available*

OMfS 17th October 2024OMfS 26th October 2024OMfS 29th October 2024Courses in 2025
Which Online HEALS course date you would like to attend (if possible, please choose more than one)?
Date unavailable? Click here to join the waitlist
You can still be added to a waiting list. Please let us know which one you would like to get contacted in case we have a place available?

HEALS 22nd Jan, Wed, 14:00-16:00HEALS 10th April, Wed, 18:00-20:00HEALS 22nd July, Tue, 10:00-12:00HEALS 13th Oct, Mon, 14:00-16:00
Under what circumstances are you in need of a bursary?*
For the 8-week mindfulness courses - we ask you to consider how much you are able to fund yourself and we will cover the remainder from our bursary fund.
How much are you able to pay (see notes above)?*
Please provide any other information you think is relevant to this application (that can include your health condition for the Health course)
Funding Monitoring Information
Why do we need this information?

Collecting this information will provide useful anonymous data that may help Breathworks to secure funding in the future. This in turn will help us award bursaries to more people, so more people will be able to benefit from mindfulness training.

The monitoring information has no basis in our decision-making process and this data will never be shared with anybody and will be held securely in accordance with the standards set out in the GDPR and the Data Protection act 2018.
Do you live with a long term physical or mental health condition?*

YesNoIf yes, please provide details of the condition
Do you have a disability?*

YesNoPrefer not to say
Are you currently unemployed?*

YesNoPrefer not to say
Are you from Black, Asian, Minority Ethnic (BAME) heritage*

YesNoPrefer not to say
Do you identify as LGBTQ+?*

YesNoPrefer not to say
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Thank you for completing the application. Please click submit and your application will be reviewed by a member of the team.
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Breathworks Courses: Bursary Request

Funding Monitoring Information

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