UMass Center for Mindfulness

Practicum in MBSR - Program Application

Please use this form to apply for admission to the Practicum in MBSR. Please refer to our website to confirm that you meet the prerequisites for this course before applying.

Form fields marked with a red asterisk * must be completed.

At the bottom of this form, you will be asked to attach your CV/Resume to the form before submitting the application. You should have this file ready on your computer, in MS Word or PDF format, before beginning to use this form.

After submitting this form, you will see a message on screen with instructions for paying the $50 application fee.

Oasis Institute Program to which you are applying
Select the Training Course to which you are applying *
8 Week Spring Practicum - April 28 - June 20, 2014 8 Week Summer Practicum - June 23 - August 15, 2014 9 Day Summer Practicum - June 8 - 17, 2014 - 121A 9 Day Practicum, Italy - July 6-15, 2014 9 Day Practicum, Germany - September 22 - October 1, 2014 9 Day Practicum, Ireland - October 1-10, 2014
Contact Information
Name First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email address *
Day time telephone number *
Evening/Weekend telephone number *
Education and Profession
Highest education degree *
Profession/area of specialty *
Use this button to attach your CV/Resume to this application. Please make sure the document is in MS Word or PDF format. *
Mindfulness-Based Stress Reduction (MBSR)

We would like to know if you have attended either of the following two courses.
Have you attended an 8-week MBSR course (at the Center for Mindfulness or elsewhere in the world)? *
Yes No
If you have participated in an MBSR course, please note the year when you took the course, the teacher's name, and the location.
Have you attended the 5-day Mindfulness Tools for Living the Full Catastrophe (adapted version of MBSR) course? *
Yes No
If you have participated in the Mindfulness Tools for Living the Full Catastrophe course, please provide the year and location of the program and the teacher name(s).
Mindfulness-Based Education and Training

We would like to know about any training and education programs you may have done with the Center for Mindfulness as well as relevant training programs with other organizations.
Have you attended the MBSR in Mind-Body Medicine 7-Day Training with Jon Kabat-Zinn and Saki Santorelli? *
Yes No
If you did participate in this 7-Day Training, what was the year and the location of the program?
Have you previously attended the 8-week Practicum in MBSR at the Center for Mindfulness? (Please note that the Practicum is a professional training program that includes and extends the MBSR course. In the past, this program was once known as an "Internship in MBSR") *
Yes No
If you did previously participate in the 8-week Practicum, please provide the year and location of the program and the teacher name(s).
Have you previously attended the 9-Day Intensive Practicum in MBSR taught by Center for Mindfulness staff? *
Yes No
If you did previously participate in the 9-Day Intensive Practicum, please provide the year and location of the program and the teacher name(s).
Have you previously attended the Center for Mindfulness Teacher Development Intensive? *
Yes No
If you did previously participate in the TDI, please provide the year and location of the program and the teacher name(s).
Have you previously engaged in Supervision or Consultation in MBSR through the Center for Mindfulness Oasis program? *
Yes No
If you have engaged in Supervision or Consultation with the CFM, please note the Supervisor's name and the date of the most recent session.
Other mindfulness-based professional trainings
If you participated in any mindfulness-based professional trainings that were offered by other organizations (not by the Center for Mindfulness), please note the title, teacher(s), and location for any such courses.
Maximum Allowed: 300 words. Currently Used: 0 words.
Mindfulness and Meditation in Your Life
Please describe your personal mindfulness practice, including meditation and movement work such as yoga. Be sure to include how long you have you been practicing. *
Maximum Allowed: 300 words. Currently Used: 0 words.
In the text box below, enter the number of mindfulness meditation retreats you have attended that qualify as prerequisites for the Practicum in MBSR by meeting ALL of the following criteria. For the purposes of MBSR teacher training, retreats must be:
- Silent;
- Teacher-led;
- At least 5-10 days in length; and
- Primarily focused on the practice of mindfulness meditation.

Please click here to see a full description of our retreat intentions and requirements. (This link will open in a new browser window in order to preserve this form.)

Please note that the "Mindfulness-Based Stress Reduction in Mind-Body Medicine 7-Day Training" and the "Mindfulness Tools for Living the Full Catastrophe" 5-Day adapted MBSR course from the Center for Mindfulness do NOT count as qualifying retreats for the Practicum.

Enter the number of qualifying retreats here: *
Enter the year, location, teacher name(s), and meditation tradition for your most recent meditation retreat that meets this requirement. *
Maximum Allowed: 150 characters. Currently Used: 0 characters.
If you have attended other meditation and yoga retreats (from any tradition) that you would like us to know about, you may note them here.
Maximum Allowed: 250 words. Currently Used: 0 words.
Mindfulness-Based Teaching Experience
If you have been teaching the complete 8-week MBSR course, note the number of courses you have taught and the approximate dates.
Maximum Allowed: 200 words. Currently Used: 0 words.
If you have been teaching mindfulness programs other than the complete 8-week MBSR course, to groups or individuals, briefly describe such teaching here.
Maximum Allowed: 250 words. Currently Used: 0 words.
In what language(s) do you teach, or plan to teach, MBSR?
Maximum Allowed: 250 words. Currently Used: 0 words.
Additional Personal and Professional Information
Please describe pathways of inner development that you have intentionally explored in depth (e.g. awareness practices, psychological investigations). *
Maximum Allowed: 500 words. Currently Used: 0 words.
Is there anything else about you and your background that would be helpful for us to know?
Maximum Allowed: 500 words. Currently Used: 0 words.
Do Not Fill This Out

UMass Center for Mindfulness

Oasis Institute Program to which you are applying

Contact Information

Education and Profession

Mindfulness-Based Stress Reduction (MBSR)

Mindfulness-Based Education and Training

Other mindfulness-based professional trainings

Mindfulness and Meditation in Your Life

Mindfulness-Based Teaching Experience

Additional Personal and Professional Information