Student Inquiry of Interest Form – Qigong Sensory Training Institute

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Please check each of the following prerequisites to show that you have met them.

I am healthy, energetic, and taking little or no chronic medication. The reason for this requirement is that Qigong Sensory Treatment (QST) utilizes the energy, intention and sensibility of the QST Certified Trainer. According to Chinese medicine, chronic illness and chronic medication decrease a person’s overall energy and sensitivity, and thus the resources they bring to bear in working with QST.
I have two or more years of professional or para-professional experience working with children on the autism spectrum.

Specifically, how/in what capacity are you currently working with autistic children and their families (what approaches, frequency, duration, and ages) and for how many years have you been providing those services? What past experiences did you have working with autistic children? What is your professional background and your discipline/job title? How do you plan to use QST after you are certified?

OR

I am a parent of an autistic child and I have completed at least 5 months of daily Qigogn Sensory Therapy with my child under the training of a QST Certified Trainer, who recommended that I apply for the QST Certified Trainer Course.

Please discuss your experience going through Qigong Sensory Therapy with your child, why you want to become a QST Certified Trainer, and who do you plan to offer QST services to

Name of your Qigong Sensory Therapy Certified Trainer:

In what year/s did you do QST with your child?

Please check each of the following statements to signal your agreement and understanding of your responsibilities to be a participant in this training course (TO BE COMPLETED BY ALL APPLICANTS):

Please check each of the following statements to signal your agreement and understanding of your responsibilities to be a participant in this training course. I declare that:

I am a QST Certified Trainer in good standing with QSTI.
I have completed QST with at least 10 families with children ages 2-12, who demonstrated positive outcomes on their pre-post test results (you will be required to submit these pre-post test forms).
I am requesting an application packet for the QSTI's Qigong Sensory Therapy Certified Master Trainer (QST-CMT) Track.
I understand that a recommendation from the Master Trainer who supervised me at the QST Certified Trainer course is required for my QST-CMT Track application to be considered.

The Master Trainer who supervised me at the QST Certified Trainer course was:

I understand that:

During my QST-CMT practicum and when I practice as a QST Certified Master Trainer I will be required to utilize the virtual teaching and supervision methodologies and technology tools required/provided by QSTI, and that in most cases in-person teaching/supervision will not be possible. QST-CMT candidates who are not able to effectively use the virtual and tech tools required during the QST-CT course to optimize their students' learning will not be able to successfully complete the Master Trainer Track and earn a certification as a QST-CMT.

By submitting this form, I certify to the truth and accuracy of the information provided on this inquiry form. By submitting this form you will be added to our mailing list.