Qigong Senior Clinical Practitioner Application Form

Qigong Senior Clinical Practitioner Application Form

Please review the entire application before beginning. This will help ensure you have all the information needed to complete each section. You may also scroll to the bottom of the form at any time to Save your progress and return later.
Contact Info

Please provide your current contact information so we may reach you regarding your application.
Name

First NameLast Name
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Phone Number
Format: (000) 000-0000.
Address

Street Address

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Postal / Zip Code
Date of Birth

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Qualifications for Qigong Senior Clinical Practitioner

Please confirm that you meet the minimum requirements for this certification before continuing with the application.
Please check the boxes below to verify that you meet the required qualifications:
Training Hour Requirement Details:

1,500 total Documented Qigong/Qigong Clinical Training hours, of which:

60% (900 hours) must be Formal Qigong Clinical Training hours (FQCT)

Up to 40% (600 hours) can be Documented non-clinical Qigong Training hours and of these 600 hours:

75% (450 of those hrs) must be Formal Qigong Training (FQT)

Up to 25% (150 hours) can also be a combination of the following five distinct categories based on

the formula for each category below, not to exceed the 150 hour maximum:

1. Virtual (Real-Time) Qigong Training (VQT)
Up to 25% (150 hours) of the 600 non-clinical Documented Qigong Training hours
2. Health Focused Tai Chi Training (HFTC)
Up to 25% (150 hours) of the 600 non-clinical Documented Qigong Training hours
3. Health Focused Kung Fu Training (HFKU)
Up to 25% (150 hours) of the 600 non-clinical Documented Qigong Training hours
4. Related Qigong Training hours (RQT)
Up to 10% (60 hours) of the 600 non-clinical Documented Qigong Training hours
5 . Asynchronous Learning hours (AL)
Up to 1% (6 hours) of the 600 non-clinical Documented Qigong Training hours
Are you presently a Professional Member of the NQA? Please note that this application requires professional membership.
Formal Qigong Clinical Training Hours (FQCT)

Documented hours of study where direct instruction is received in an in-person class setting from an instructor. These hours include energetic anatomy & physiology, Qi transmission through non-touch and/or light touch methods, and recommendation of Qigong exercises and meditations. This training teaches the development of skills, derived through formal instruction and self-cultivation, in the assessment, clearing, and direct treatment of one’s physical, mental, emotional, and spiritual (consciousness) alignment rooted in Taoist, Buddhist, and Traditional Chinese medical principles. The clinical application of Qigong integrates Formal Qigong Training into Clinical Training and includes Chinese medical theory and Qigong history, theory, and philosophy. Other techniques and practices such as acupressure, cupping, and adjunct therapies may also be taught. Curriculums vary between schools. Note: 60%, (900 hours) of the required 1,500 Documented Qigong/Qigong Clinical Training Hours must be FQCT hours and listed below..
Provide start date, end date, course or form studied, instructor or school, and total training hours.
Total Formal Qigong Clinical Training Hours: Enter the total of the hours listed above.
Note: 60%, (900 hours) of the required 1,500 Documented Qigong/Qigong Clinical Training Hours must be FQCT hours.
Formal Qigong Training Hours (non-clinical) (FQT)

Documented method of in-person training where students physically attend and receive group and/or private instruction. In this method, students interact in-person with a teacher/instructor. Formal Qigong Training includes the cultivation and perception of Qi, the experience of Qi and the Qigong state, Centering, Grounding, Rooting, knowledge of Qigong theories of what Qi is and how it works, an understanding of the three Dan Tian's, Jing, Qi, and Shen, Yin/Yang, Five Phases, and Meridian/Acupoint system. It includes utilization of Qi in practice, teaching, and Qi emissions. Note: A minimum of 450 hours of you required Documented Qigong/Qigong Clinical Training Hours must be Formal Qigong Training Hours (FQT).
Provide start date, end date, course or form studied, instructor or school, and total training hours.
Total Formal Qigong Training Hours: Add the hours listed above and enter the total.
Note: A minimum of 450 hours of your training must be non-clinical Formal Qigong Training Hours (FQT).
Virtual (Real-Time) Qigong Training (VQT)

Documented method of online, real-time training where students interact in person with their teacher/instructor and can see and speak to each other in a group or private instruction setting. (i.e. FaceTime, Zoom). In this method, Qigong Training includes the cultivation and perception of Qi, the experience of Qi and the Qigong state, Centering, Grounding, Rooting, knowledge of Qigong theories of what Qi is and how it works, an understanding of the three Dan Tian's, Jing, Qi, and Shen, Yin/Yang, Five Phases, and Meridian/Acupoint system. It includes utilization of Qi in practice, teaching, and Qi emissions. Note: Up to 25%, (150 hours) of the 600 non-clinical Formal Qigong Training Hours can be (VQT) hours not to exceed the combined category allowance of 150 hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours.
Total Virtual Qigong Training Hours: Add the hours listed above and enter the total.
Note: Up to 150 hours can be VQT hours
Health Focused Tai Chi Training (HFTC)

Documented in person training hours which include foundational Qigong Principles taught within the context of Tai Chi Training. Please state the style of Tai Chi you studied such as Yang, Chen, Wu, and Sun. Note: Up to 25%, (150 hours) of the 600 non-clinical Formal Qigong Training Hours can be (HFTC) hours not to exceed the combined category allowance of 150 hours. 
Provide start date, end date, course or form studied, instructor or school, and total training hours.
Total Health Focused Tai Chi Training Hours: Add the hours listed above and enter the total.
Note: Up to 150 hours can be HFTC hours
Health Focused Kung Fu Training (HFKF)

Documented in person training hours which include foundational Qigong Principles taught within the application of Martial Training. Please state the style of Kung Fu you studied such as: Hung Gar, White Crane, and Long Fist. Note: Up to 25%, (150 hours) of the 600 non-clinical Formal Qigong Training Hours can be (HFKF) hours not to exceed the combined category allowance of 50 hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours.
Total Health Focused Kung Fu Training Hours: Add the hours listed above and enter the total.
Note: Up to 150 hours can be HFKF hours
Related Qigong Training (RQT)

Documented in person and/or virtual training hours related to but not defined as Qigong and/or Qigong Clinical training hours (as defined in the NQA Definitions of Terms for Certification). This category includes: Tai Chi, Martial Arts, and/or Qigong Religious training, as well as training in healing art forms. All documented Related Qigong Training hours must incorporate some of the basic principles of Qigong such as Yin/Yang, the three Dan Tian's, Jing, Qi, Shen, meridian point knowledge, and the Five Phases. Note: Up to 10%, (60 hours) of the 600 non-clinical Formal Qigong Training Hours can be (RQT) hours not to exceed the combined category allowance of 60 hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours.
Total Related Qigong Training Hours: Add the hours listed above and enter the total.
Note: Up to 60 hours can be RQT hours
Asynchronous Learning (AL)

A form of learning in which the study and practice of Qigong is accessed when and wherever a student wants and personally engages in the principles and practice put forth. There is no live student & teacher interaction. Categories include: Books, Blogs, DVDs and Self-study Audio/Video On Demand (pre-recorded classes/course and training modules). Note: Up to 1%, (6 hours) of the 600 non-clinical Formal Qigong Training Hours can be (AL) hours not to exceed the combined category allowance of 6 hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours.
Total Asynchronous Learning Hours: Add the hours listed above and enter the total.
Note: Up to 6 hours can be AL hours
Please provide supporting documents for training hours. Examples include certificates of completion, training schedule, and letters of reference.

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Questions

Please answer the following questions to help the Certification Committee better understand your training background, teaching experience, and approach to Qigong.
1. Are you now or have you been a student of a certified NQA Senior Teacher Level IV?
2. If yes, of whom? If no, what are the names of your primary teachers?
NOTE: A student of an NQA Certified Senior Teacher may, in lieu of presenting documentation from that teacher, submit a strong letter of recommendation from the NQA Certified Senior Teacher that includes the number of hours of relevant instruction, a general description of coursework, and comments about the student’s ability. Hours of experience must still be listed on this application. If your primary Qigong teacher or other important teachers who helped shape your practice are deceased or cannot be reached, please include a reference letter from someone within the school or lineage, or from a fellow student who trained with you at the time.
3. What type/style of Qigong do you use in your clinical practice and why?
4. When did you start the practice of Qigong healing? (month/year)
5. When did you start performing treatments on clients outside of a class setting? (month/year) This would be time spent independently as a clinician in cultivation of healing others primarily through Qigong application.
6. What is the current schedule of your Qigong healing practice? Please list the average number of patients you see per week and average time spent with each patient.
7. Tell us more about your Qigong clinical practice experience.
8. If you write articles, books, or published papers about Qigong, when did you start? (Please skip this question if it doesn’t apply to you)
9. In your own words, how would you describe the essential principles behind your clinical Qigong practice?
10. How would you explain the interaction of Jing, Qi, and Shen in the context of clinical practice?
11. What is the role of mind/intention in clinical Qigong practice for you?
12. How would you begin and end your clinical practice to be most effective?
15. Please describe any additional insights about your Qigong Clinical practice that you feel to share.
16. In your own experience, have you found certain situations in which your clinical practice is an inappropriate application of Qigong?
17. Have you ever been convicted of a crime? If “yes”, please explain briefly
18. Have you ever been denied a professional license/certification or had one revoked? If “yes”, please explain briefly.
Letters of References

Please arrange for three (3) letters of reference to be sent directly from your references to the NQA Certification Liaison at certification.liason@nqa.org

A. Reference Letter from a Primary Qigong Teacher

This letter should describe the Qigong training for which you reported training hours in this application.

This reference should include:
- A brief description of the reference’s background as it relates to your Qigong studies
- How long the reference has known you
- How long you studied with this reference
- The subjects studied and the duration or frequency of your training
B. Professional Reference from a Supervisor, Peer, Student or Client

This reference should include:
- How the reference knows you
- How long the reference has known you
C. Reference to Personal Character

This reference should include:
- How the reference knows you
- How long the reference has known you
Please list the individuals from whom the committee should expect to receive letters of reference:
Primary Qigong Teacher Reference
Professional Reference
Personal Reference
Attestation

I attest that all information submitted in this application is truthful and accurate to the best of my knowledge. I understand that incomplete or intentionally misleading information may result in the denial of certification. Please sign and date below.
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Application Fee

The application fee helps support the time and administrative work required for the Certification Committee to review and evaluate each submission.

$100.00 Quantity

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Qigong Senior Clinical Practitioner Application Form

Contact Info

Qualifications for Qigong Senior Clinical Practitioner

Formal Qigong Clinical Training Hours (FQCT)

Formal Qigong Training Hours (non-clinical) (FQT)

Virtual (Real-Time) Qigong Training (VQT)

Health Focused Tai Chi Training (HFTC)

Health Focused Kung Fu Training (HFKF)

Related Qigong Training (RQT)

Asynchronous Learning (AL)

Questions

Attestation

Application Fee*

Application Fee