Eurythmy Mentoring Intake | Heart of Mervin

Eurythmy Teacher Mentoring & Consultation · First Session Intake

A space for your Eurythmy teaching, and for you

Welcome. This short form helps me prepare for our first meeting and understand what would be most helpful to you.

Please allow approximately 10–15 minutes. Brief answers are enough. You can leave optional questions for our conversation. Fields marked with an asterisk (*) are required.

For tick-box questions, select up to three options unless otherwise stated.

Please keep teaching examples anonymous. Do not include pupils’ names, identifying details, photographs, recordings or confidential school records.

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Client information – Step 1 of 5

Fields marked with a red asterisk () are required.

1. Client information

Name *

First

Last

Email *

Phone number, including country code

Mailing address

City and postal code

Country

Time zone

Date of birth (optional)

Gender (optional)

Emergency contact name and phone number (optional)

Information about how Heart of Mervin handles personal data is available in the Privacy Policy and GDPR information (open in new tabs).

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2. Common information

How did you hear about Heart of Mervin?

Internet / search engine
Friend or colleague
Social media
Professional referral
Third-party review
Other

Select up to three.

Comments (optional)

Have you experienced kinesiology before?

Yes
No
Prefer to discuss during our meeting

Select one.

Have you received professional mentoring before?

Select one.

Anything useful to know about these experiences? (Optional)

3. Your teaching background

Your current situation

In training or beginning teaching
Currently teaching
Returning after a break
Changing role or setting
Developing workshops or independent work
Other

Select up to three.

Briefly describe your training and teaching experience.

A few words or sentences are enough.

Which classes or age groups do you teach?

Include approximate group sizes and how often you meet them.

Who is arranging the mentoring?

I am arranging it myself
My school or organisation is supporting it
Other

Select one.

School or organisation, and any expectations about feedback or reporting (if applicable):

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4. What would help you most?

What would you most like us to focus on?

Lesson planning and progression
Age-appropriate curriculum and teaching methods
Speech Eurythmy, poetry and storytelling
Tone Eurythmy and musical material
Spatial forms, exercises and movement
Lesson rhythm and group engagement
Different abilities and participation needs
Teacher presence, confidence and boundaries
Working with musicians, colleagues or parents
Performances, projects or workshops
Artistic renewal and inner development
Workload, wellbeing or professional direction
Other

Select up to three.

Comments (optional)

What is the main question or situation you would like to bring to our first meeting?

Two or three sentences are enough. We can explore the details together.

What is already going well—or gives you enjoyment in your teaching?

What would you like to leave our first meeting with?

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5. Teaching materials

Would you like help finding or developing material?

Yes
No
I would like to discuss this

Select one.

If you would like help with materials, please choose one class or age group for this intake form. You may select Speech Eurythmy, Tone Eurythmy, or both.

Class / grade

Pupils’ age or age range

Type of eurythmy

Speech Eurythmy
Tone Eurythmy

Tick one or both.

What would be helpful?

Poetry, verses or stories
Music suggestions
Spatial forms
Exercises and activities
A complete lesson structure
A sequence of lessons or term plan
Performance or project material
Adapting material I already use
Other

Select up to three.

Theme, season, teaching aim or specific wishes (optional):

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6. Preparing for our meeting

What kind of support would suit you best?

Space to speak and reflect
Practical suggestions and examples
Exploring artistic material together
Feedback on a plan, form or exercise
Questions that help me find my own approach
A few clear steps to try afterwards

Select up to three.

Is there anything about your setting, access needs or personal boundaries that would help me prepare?

Optional. You may discuss this during the meeting instead.

Any other question or comment? (Optional)

You are welcome to bring a lesson plan, poem, piece of music, spatial form or exercise. There is no need to prepare additional material specifically for our first meeting.

(optional): (optional) kinesiology

7. Confirmation

Please read the following statements:

The information I have provided is accurate to the best of my knowledge.
I have read and understood the Policies and Procedures of Heart of Mervin (opens in a new tab).
I understand that mentoring includes pedagogical, artistic and personal reflection. We agree on the focus together, and I remain responsible for my professional decisions.
I have kept teaching examples anonymous. Sharing pupil records or recordings requires a separate discussion and appropriate permissions.
I may decline an exercise, choose not to discuss a personal matter, or ask to pause or change direction.
Mentoring does not replace medical or psychological care.

Confirmation (required) *

I have read and understood the statements above and confirm them by submitting this form.

Please tick this box before submitting your form.

Typed full name *

Date *

Thank you. We will begin with what matters most to you and find a manageable next step together.

Mervin Wilk
Eurythmy Teacher · Eurythmy Therapist · EMK Practitioner & Instructor
Heart of Mervin · Health · Art · Education

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