MSC Teacher Training Application Form Dear applicant, We have carefully assembled the following questions in order to help select the most suitable candidates for MSC Teacher Training. Answers will necessarily include personal information, but this information will be viewed by the MSC Teacher Training Team only and treated confidentially. Should you not want to answer any of the questions in writing, you may note this in the response area for that question and include contact information (telephone or email address) at which you can be contacted to discuss it privately. Similarly, the teacher training team may contact you to have a private conversation in order to clarify some of your answers on the form. Please understand that all other information still needs to be submitted in writing. Please note that the Center for Mindful Self-Compassion strongly recommends that you NOT schedule your first MSC course until after you successfully complete the MSC Teacher Training, to assure that you are fully ready to begin teaching. Thank you.Name* First Last Email* Please upload your profile picture.EDUCATION & PROFESSIONAL QUALIFICATIONSDegree or highest level of education attained*Profession*Current work activities*MSC Teacher Training Month and Year you are applying for.*January 2018 EarthRise Retreat Center Teacher TrainingJune 2018 Ontario Canada Teacher TrainingSeptember 2018 Australia Teacher TrainingCountry of Residence*1.Please list the details (year, location and teacher(s)) of the 8-week or 5-day intensive MSC program you have completed (meaning you attended at least 6 of the 8 weekly sessions and received documentation of completion). This is required and must be completed at least six months prior to attending Teacher Training. (Please attach a copy of your certificate below, if available.)*Please attach a copy of your certificate, if available.2. Please describe your personal mindfulness, compassion and self-compassion practice, and provide details (date, location and teacher(s)) of your participation in at least one 5-day teacher-led silent retreat.*3. Please describe any experience you have with teaching mindfulness to others.*4. Please provide a brief essay introducing yourself and describing your interest in teaching MSC, specifically incorporating your reflections on the essay provided to you, entitled "On Becoming a MSC Teacher: A Mountaineer’s Guide to Building the Resource of Mindful Self- Compassion" (200 words or less). (To access the essay, copy and paste the following URL: http://mbpti.org/wp-content/uploads/2014/10/MSC-TT-Pre-Registration-Self-Reflection.pdf)*5. This teacher training program focuses on building skills specific to MSC which includes a significant amount of constructive feedback while practice teaching. Generally, how do you typically receive such feedback and how do you work with it?*6. MSC can be emotionally activating for participants and requires teachers to be able to emotionally regulate themselves. Can you give a brief example of situations in which you might "lose your balance" while teaching and how you would respond?*7. MSC teachers need to practice what they are teaching. Please provide a brief specific example of how you have used self-compassion and/or the practices of MSC to work with your own difficult emotions like fear, shame or anger?*PAST APPLICATIONSHave you ever been turned down from an MSC Teacher Training? If yes, what have you done to fulfill the prerequisites since being declined?*YesNoIf yes, could you please describe the reasons you were declined and the steps you have taken to try to address the concerns?MENTAL HEALTH Being affected by a mental health diagnosis may not necessarily prevent you from becoming an MSC Teacher. However, when teaching MSC to others, we must be in touch with and hold our own human vulnerability with great kindness in order to be a model to others and as such, we carry great responsibility for the safety of our students. We also need to be able to recognise and to hold the feelings of vulnerability within our students with great stability, calm, courage, wisdom and kindness. From our experience MSC teachers are of greatest benefit to their students when they teach from such a solid place and already have plenty of room in their own hearts for others’ difficulties, which is not always possible when the teachers themselves have ongoing significant struggles with these issues. We understand that answers to these questions may not be straightforward and are personal. Please feel free to opt for a private conversation if you prefer that by including a note as your response to any of these questions as to how and when we may contact you for this. Do you carry a mental health diagnosis? If yes, how does that impact on your work?* Yes No Do you suffer from a trauma-related disorder?* Yes No If you answered yes to one of the above, how would you describe your current status. Current In partial remission In full remission How do your symptoms currently manifest and how do they impact on your teaching of mindfulness or other professional work?