SMART FACILITATOR TRAINING PATHWAY APPLICATION

Level 1 Certification Requirements
Prerequisites - Completion of the following:
• An established mindfulness practice including meditation and mindful movement,
• Completion of Mindfulness-Based Stress Reduction course (MBSR) as a participant or equivalent (MBCT, other)
• Completion of Mindful Self-Compassion (MSC or SC-MSC) as a participant
• Attending and Completing the submission Requirements for one 20-hour smartEducation course
• A residential teacher led silent retreat that is a minimum of three to seven days in duration (seven days preferred)
• Experience teaching adults and facilitating professional development activities for teachers
Professional degree and/or equivalent experience - Academic Qualifications:
• Undergraduate degree in education, psychology, health sciences, social work, or equivalent degree, or
• Advanced professional degree and/or equivalent experience

1Participant Information > 2Any other information > 3Review Your Entry
Name Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email (to receive SMART information) *

We will be sending you weekly information to support you in the SMART program, including resources and home practice reminders. Please let us know your preferred email.
Home Phone Home Phone * - ### - ### ####
Cell Phone Cell Phone * - ### - ### ####
Employer/ Name of school / Organization
What grades do you teach?

What grades do you teach? K-6 7-8 9-12 Other Other
Please tell us why you would like to become a SMART Facilitator. *
Please tell us about your plans to teach mindfulness to educators and / or students (ages, level, dates, program) *
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Prerequisite Completion Section

Completion of Level 1 prerequisites: *
Completion of Level 1 prerequisites:	Yes	No
1. An established mindfulness practice including meditation and mindful movement	1. An established mindfulness practice including meditation and mindful movementYes	1. An established mindfulness practice including meditation and mindful movementNo
2. Completion of one online or face to face Mindfulness-Based Stress Reduction course (MBSR) as a participant or equivalent (MBCT, MSC, other)	2. Completion of one online or face to face Mindfulness-Based Stress Reduction course (MBSR) as a participant or equivalent (MBCT, MSC, other)Yes	2. Completion of one online or face to face Mindfulness-Based Stress Reduction course (MBSR) as a participant or equivalent (MBCT, MSC, other)No
2. Completion of one Mindful Self-Compassion course (MSC or SC_MSC) as a participant	2. Completion of one Mindful Self-Compassion course (MSC or SC_MSC) as a participantYes	2. Completion of one Mindful Self-Compassion course (MSC or SC_MSC) as a participantNo
4. Attending and completing one 20 hour smartEducation course	4. Attending and completing one 20 hour smartEducation courseYes	4. Attending and completing one 20 hour smartEducation courseNo
5. A residential teacher led silent retreat that is a minimum of three to seven days in duration (seven days preferred)	5. A residential teacher led silent retreat that is a minimum of three to seven days in duration (seven days preferred)Yes	5. A residential teacher led silent retreat that is a minimum of three to seven days in duration (seven days preferred)No
6. Experience teaching adults and facilitating professional development activities for teachers	6. Experience teaching adults and facilitating professional development activities for teachersYes	6. Experience teaching adults and facilitating professional development activities for teachersNo

1. MINDFULNESS PRACTICE
Please describe your personal mindfulness practice including meditation and mindful movement.
2. MBSR WORKSHOP COMPLETION

Please list
- Start date of workshop
- Completion date of workshop
- Location
- Facilitator Name
- Retreat Date
2. MSC WORKSHOP COMPLETION

Please list
- Start date of workshop
- Completion date of workshop
- Location
- Facilitator Name
- Retreat Date
Upload MSC Certificate of Attendance Here

Attach Files
3. SMART Workshop COMPLETION

Please list
- Start date of workshop
- Completion date of workshop
- Location
- Facilitator Name
- Retreat Date
Upload SMART Certificate of Completion Here

Attach Files
3. SILENT RETREAT (3 -7 days) COMPLETION

Please list
- Retreat Date
- Length of Retreat
- Location
- Facilitator Name
- Location
- Teacher Name
Upload RETREAT Certificate of Attendance Here

Attach Files
4. ADULT TEACHING EXPERIENCE
Please describe your experience teaching adults and facilitating professional development activities for teachers
OTHER MINDFULNESS / YOGA
/ MEDITATION TRAINING
Please describe any other training / certifications that you have completed.

Please list
- Name of Training
- Date of Training
- Length of Training
- Location
- Teacher Name
Undergraduate degree in education, psychology, health sciences, social work, or equivalent degree, or
Advanced professional degree and/or equivalent experience

Please provide details
Upload DEGREES Here

Attach Files

You may upload up to 5 files.
Any other information that you’d like us to know
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Enter Your Email Address *

A special link to resume the form will be sent to your email address.

SMART FACILITATOR TRAINING PATHWAY APPLICATION

SMART FACILITATOR TRAINING PATHWAY APPLICATION

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