Student Inquiry of Interest Form – Qigong Sensory Training Institute

Enrollment Application

Name *

First

Last

Preferred Pronouns *

How did you hear about QST and QSTI's trainings? *

Address *

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City

State / Province / Region

Postal Code

Country

Email *

Phone Number *

Preferred Language *

Course *

When would you like to start your course? *

I am *

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 autistic children.

Please help us understand your experience and professional background. What is your profession and job title? *

How/in what capacity are you currently working with autistic children and their families (what approaches, frequency, duration, and ages)? *

How many years have you been providing the services you listed in the previous question? *

What past experiences did you have working with autistic children? *

How do you plan to use QST after you are certified? *

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 am a parent of an autistic child and I have completed at least 5 months of daily Qigong 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 help us understand your experience with QST. How was your experience going through the Qigong Sensory Therapy plan of care with your child? *

Why do you want to become a QST Certified Trainer? *

Who do you plan to offer QST services to? *

Name of your Qigong Sensory Therapy Certified Trainer: *

E-mail address/Phone number 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): *

Recruit a family before the beginning of the course with a child that meets the eligibility criteria to participate in the training (the child and family should not be your own family members).
Assist the child’s parent/guardian to complete the family intake process no later than the first week of the course.
Participate in the 5-week online Education course, complete all assignments, and participate in the weekly live sessions.
Participate in the 5-month distance Supervision course with the family I recruited, including the following:
Schedule QST sessions with my supervising Master Trainer.
Attend the two schedule conference calls and present my case study.
Assist in the collection of pre- and post-test data for the child with whom I am working.
Complete all QST sessions with the child /family with which I am working.
Hold an exit interview with the parents.
At the completion of the course, sign and submit the QST Certified Trainer Agreement.
At the end of the course, destroy any recorded material of course-related sessions made during the course (unless I have a signed authorization to maintain them).
Most students find that distance supervision works well for them. Occasionally a student has found that their learning style is not a good match for distance supervision. In-person supervision is usually unavailable, unless the student and supervisor happen to live near each other. Students who are not able to master the QST therapy with distance supervision will not be able to successfully complete the course and graduate.
I am aware that the course materials are in English, and I will be able to take the course in English.

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.
I am aware that the course materials are in English, and I will be able to take the course in English.

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.

QSTI courses are offered through Canvas, which communicates via email. Upon registration, you'll be invited to create a Canvas account. Please provide the email address you would like us to use for Canvas: *