Credential Renewal

DO NOT Complete this Form! Use this Instead---https://forms.gle/ywLRubFvCJ96zjFH7

First Middle Last

Title

Organization

Do you need to edit your contact information?

Yes

CONTACT INFORMATION

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website

Phone

Skype

Social Media Profiles

Facebook

ACCREDITATION/CERTIFICATION INFORMATION

Do you currently have an IMTA Teacher Certification or Accreditation?

Yes

Accreditation/Certification Type (check all that apply)

CMT-P

CMT-M

CMT-E

AMTT-P

Do you hold any teacher certifications from other organizations?

Yes

If yes, list certification/year issued

Describe any recent training you have taken, hosted and/or taught:

ORGANIZATIONAL MEMBERSHIP

Do you want to renew or join as an organizational member? (optional)

Yes

Select level of organizational membership

3 - 5 Teachers ($375)

6 - 9 Teachers ($675)

10 - 15 Teachers ($975)

More than 15 Teachers (contact for pricing)

ADDITIONAL INFORMATION

General Experience

Tell us about your background and give us an idea of the experience you currently have with the mindfulness community.

Please list any changes to your program since you accredited with IMTA. Indicate N/A if none.

Upload any supporting documentation of your professional development or recent trainings

Max. file size: 128 MB.

I have completed the separate Google Form--- https://forms.gle/DDnZFCHxQp4eXMHa6(Required)

In submitting this application, I fully understand that it is an application only and does not guarantee certification. I understand and, by my signature, attest that I have completed the application to the best of my knowledge. I understand that the IMTA reserves the right to revise or update this application; and that it is my responsibility to be aware of these current requirements. I further understand that I am obligated to inform IMTA of changed circumstances that may materially affect my application. I further understand that it is my responsibility to provide any requested documentation in connection with this application. I understand and agree that if I am certified following acceptance of this application, such certification does not constitute a warranty or guarantee of my fitness or competency to practice as a mindfulness professional. If I am certified, I authorize IMTA to include my name in a list of certified individuals and agree to use the IMTA designation and related trade names, trademarks, and logos only as permitted by IMTA policies.

Electronic Signature(Required)

Apply for Accreditation/Certification Renewal

IMTA Accreditation/Credential Renewal Application

CONTACT INFORMATION

ACCREDITATION/CERTIFICATION INFORMATION

ORGANIZATIONAL MEMBERSHIP

ADDITIONAL INFORMATION