Diverse Community MBSR Teacher Training Scholarship Application Form

This need-based scholarship program is intended to support those individuals who: 1) have a dedication and plan to use MBSR to support the well-being of diverse, multicultural communities in U.S.A. and 2) will focus their teaching on serving those communities most impacted by injustice, economic oppression and structural racism.

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* 1. Please provide the following basic personal information.

Name *

Address

Address 2

City/Town *

State/Province *

ZIP/Postal Code

Country *

Email Address *

Cell Phone Number

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* 2. Are you currently employed?

Yes

If yes, please tell us your occupation.

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* 3. Gross annual household income.

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* 4. Number of people supported by your income.

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* 5. What is your educational history?

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* 6. Do you identify as a person with a disability or disabilities?

Yes

If yes, please describe anything you might need to ensure your full participation, if accepted.

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* 7. Years of meditation practice

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* 8. What lineage (or type of practice)?

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* 9. Have you attended an in-person 8-week MBSR course?

Yes, I've taken an in-person 8-week MBSR course.

Yes, I've taken a live online 8-week MBSR course.

Yes, I've taken a recorded version of 8-week MBSR course.

No, I haven't taken an 8-week MBSR course yet.

If yes, please list month/year, location and the name of the teacher(s) of the class you attended.
If you haven't taken an 8-week MBSR, please list dates, location and the name of the teachers of the class you are registered.

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* 10. Have you attended residential silent Mindfulness retreats?

Yes

If yes, please list when and where.

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* 11. If you have not attend any residential silent Mindfulness retreats, would you like financial assistance with attending one?

Yes

Here are some retreats offered through UC San Diego MBPTI. We have scholarship funds available for these silent retreats:

April 6-11, 2020 at Duncan Center in Delray Beach, FL
June 30-July 5, 2020 at Santa Sabina Retreat Center in San Rafael, CA
August 2-7, 2020 at Rolling Ridge Retreat Center in North Andover, MA

If you're not able to attend a silent retreat sponsored by UC San Diego CFM, you can participate in any teacher-led silent mindfulness meditation retreat of at least 5 nights (6 days) offered by others. (UC San Diego CFM scholarship funds are not available for retreats offered by others.)

Here is an example of other organizations that offer silent retreats:

Beth Mulligan’s organization Mindful-Way
InsightLA
Spirit Rock
Copper Beech Institute
Center for Mindful Self-Compassion

You can view a list of other retreat centers here.

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* 12. Please tell us a little bit about yourself: your current economic situation, why you're interested in this training and what taking it would mean to you.

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* 13. Please include a 500-word or less essay, answering the following questions: 1) What life experience and skills do you have with working with diverse multicultural populations and communities? 2) What life experience and skills do you have working with oppression, racism, homophobia, and discrimination? 3) How would you bring Mindfulness to communities most impacted by injustice, economic oppression and structural racism?

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* 14. Where did you hear about this program (MBSR Teacher Training for Diverse and Underserved Communities)?

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* 15. Any Questions?

Thank you for taking the time to fill out the application.

We will contact you within 5-7 business days.

UC San Diego Center for Mindfulness