Student Inquiry of Interest Form – Qigong Sensory Training Institute

Name

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Last

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

Address

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City

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Email

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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. Giving this therapy can be physically demanding and may require the flexibility to work from a range of positions including the floor.
I have two or more years of professional or para-professional experience working with autistic children.

What is your profession and job title?

What has your experience been working with autistic children and their families? What is your current role (what approaches, frequency, duration, and ages)?

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

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.

How has your experience been using Qigong Sensory Therapy 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 confirm your agreement. I will:

Review the general schedule here. I understand that attendance is required at all live sessions.
Recruit a family before the beginning of the course using this eligibility criteria and ensure they complete the family intake process no later than the first week of the course.
Participate in the 5 week online education course, the 5 month distance supervision courses.
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 24 sessions with the child/family with which I will be working, according to the course schedule as posted on the course web page.
Hold an exit interview with the parents.
Complete the QST Certified Trainer Agreement and destroy any recorded course content unless I have QSTI’s permission to do otherwise.

I understand:

This is a remote learning course. Remote supervision works well for most students. In-person supervision is typically unavailable. Students must demonstrate competency when delivering QST in order to be certified.
That the course materials are in English, and I confirm that 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: