MSC Application — oneheartmind

8 week MSC Course Online Registration

Thank you for your interest in the Mindful Self-Compassion Program.

As we aim to build community and establish a safe container for our time together, please provide the following background information to help determine if the MSC course will be helpful to you at this time, and so that your teachers can best support you during the program.

Registration Information

MSC is a compassion skills training program, not group therapy. This program is designed to teach participants the tools needed to develop and cultivate mindfulness and self-compassion practices.
This experiential course includes: meditations, short talks, exercises, full and small group discussions, mindful movement, journaling/reflection, and home practice.
Each week home practices will be given to support and deepen your experiential understanding of the material and practices, we encourage up to half an hour a day of home practice (formal and informal) during the program.
The goal of the program is for participants to directly experience self-compassion and learn practices that evoke self-compassion in daily life.
We invite all participants to set intentions, as circumstances allow, to attend all sessions and to include some daily practice for the skills learned throughout the program.
If you think you may need to miss more than two classes during the dates listed above, we encourage you to register for a future course.
Everyone is welcome, including people of all backgrounds and identities.
No previous experience with mindfulness or meditation is required to attend MSC.

Name

First Name

Last Name

Address

Phone

(###)

###

####

Date of Birth

YYYY

Gender identification

Are you currently able to attend the entire course including the half day retreat? Or are there any classes that you are currently not available for, but you would still like to join the course?

What motivates you and or brings you to taking this course?

Do you have a regular practice of meditation? If so, what type and how many years have you been practicing? It is not necessary to have any meditation experience prior to this program.

Do you have any meditation retreat experience?

Do you have any physical illness or limitation that may impact your participation in the program? If yes, please describe.

Are there any stressful life circumstances that might make this program difficult for you at this time (eg. recent loss of a loved one or job, life transition, substance abuse, fasting)

Are you currently seeing a therapist or counselor? If yes, is your counselor aware that you are attending this course?

Are you currently taking any psychoactive medication, or any medication that may affect how you feel during MSC? If so, please provide details.

The MSC program is a compassion skills training program, and not group therapy. However, you will be invited to explore, with teacher support, at varying and manageable depths and lengths, how one responds to difficult emotions and challenging situations at various times in the course. Do you have any concerns or questions about your readiness to participate in this type of program at this time? Choose One:

Option 1: YES I have some concerns and I would like to discuss further with a teacher.

Option 2: NO, no concerns at this time.

Is there anything else that might be helpful for the facilitators to know at this time?

By clicking below, I am acknowledging that i have read and understood the registration guidelines above, i have answered the intake questions to the best of my ability at this time, and i acknowledge the following: I understand that my participation in this program is entirely voluntary and I am free to withdraw at any time. I also understand that I am responsible for my personal safety and well-being and will practice self-care throughout the program.

I am in Agreement