Clone of Qigong Instructor Level I Application Form

Qigong Instructor Level II Application Form

Please review the entire application and read the NQA Definitions and Terms for Certification 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. Please be sure to include all training hours acquired to date as they carry forward to future certification applications.
Contact Info

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

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

Street Address

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Date of Birth

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Qualifications for Qigong Instructor Level II Certification

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 following qualifications:*

350 Documented Qigong Training Hours3 years personal Qigong practice2 years experience teaching Qigong3 letters of reference
- 75%, (262.5) Documented Training Hours must be Formal Qigong Training (FQT) hours.
- Up to 25% can be a combination of the following five distinct categories not to exceed 87.5 hours based on the formula for each category:
  
  1. Virtual (Real-Time) Qigong Training (VQT)
  Up to 25% (87.5 hours) of the required training hours
  2. Health Focused Tai Chi Training (HFTC)
  Up to 25% (87.5 hours) of the required training hours
  3. Health Focused Kung Fu Training (HFKF)
  Up to 25% (87.5 hours) of the required training hours
  4. Related Qigong Training hours (RQT)
  Up to 10% (35 hours) of the required training hours
  5. Asynchronous Learning hours (AL)
  Up to 1% (3.5 hours) of the required training hours
Please check the boxes below to ensure that you understand the process and meet the minimum requirements for this level of certification.

I have read the NQA Definitions And Terms For Certification - https://www.nqa.org/definitionsI meet the stated minimum requirements for this level of certification.I am a Professional Member of the NQA. (If you are not presently a Professional Member, visit the Membership section of NQA.org to become one as it is required for certification)
Formal Qigong Training Hours (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. Refer to the NQA Definitions And Terms For Certification for additional information. Note: a minimum of 75% (262.5 hours) of the required 350 Hours for Level II must be FQT hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours. (Example: Jan 2022 - Mar 2022 | Five Elements Training | Qigong School | 30 hrs.)
Total Formal Qigong Training Hours: Add the hours listed above and enter the total.
Note: Up to 75% of your required 350 hours of Documented Training must be in-person FQT for Level II NQA Certification.
Virtual (Real-Time) Qigong Training Hours (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. (ex. FaceTime, Zoom), as described in the NQA Definitions And Terms For Certification. Note: Up to 25% (87.5 hours) of the required 350 Hours for Level II can be applied to the total Combined Category allowance not to exceed 87.5 hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours. (Example: Feb 2023 – Apr 2023 | Eight Brocades Online Course | Sifu Lin | 20 hrs.)
Total Virtual Qigong Training Hours: Add the hours listed above and enter the total.
Note: Up to 25% (87.5 hours) of the required 350 Hours for Level II can be applied to the total Combined Category allowance not to exceed 87.5 hours.
Health Focused Tai Chi Training Hours (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, Sun. Note: Up to 25% (87.5 hours) of the required 350 Hours for Level II can be HFTC hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours. (Example: Jan 2022 - Mar 2022 | Yang Style for Health | Tai Chi School | 30 hrs.)
Total HFTC Hours: add the hours listed and enter the total.
Note: Up to 25% (87.5 hours) of the required 350 Hours for Level II can be applied to the total Combined Category allowance not to exceed 87.5 hours.
Health Focused Kung Fu Training Hours (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, Long Fist. Note: Up to 25% (87.5 hours) of the required 350 Hours for Level II can be HFKF hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours. (Example: Jan 2022 - Mar 2022 | Five Elements | The Center Place | 30 hrs.)
Total HFKF Hours: add up the hours listed and enter the total below:
Note: Up to 25% (87.5 hours) of the required 350 Hours for Level II can be applied to the total Combined Category allowance not to exceed 87.5 hours.
Related Qigong Training Hours (RQT)

Documented in person and/or virtual (real-time) 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 that are Meridian or Acupoint based and incorporate foundational Qigong principles. Please list all relevant study acquired to date. Note: Up to 10% (35 hours) of the required 350 Hours for Level II can be RQT hours.
Provide start date, end date, course or form studied, instructor or school, and total training hours. (Example: Jan 2020 - Mar 2020 / Organ Cleansing / CommunityAwake / 50 hrs))
Total RQT Hours: add up the hours listed and enter the total below:
Note: Up to 10% (35 hours) of the required 350 Hours for Level II can be applied to the total Combined Category allowance not to exceed 87.5 hours.
Asynchronous Learning Hours (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% (3.5 hours) of the required 350 Hours for Level II can be AL hours.
Provide Year, Category, Title, Topic, or Form studied, instructor or school, and total learning hours. (Example: 2008 | On-demand Video | Five Elements Training | Qigong Institute | 30 hours)
Total AL Hours: add the hours listed and enter the total.
Note: Up to 1% (3.5 hours) of the required 350 Hours for Level II can be applied to the total Combined Category allowance of 87.5 hours.
Please provide supporting documents for training hours. Examples include certificates of completion, training schedule, and letters of reference.

Cancelof
Teaching Experience

Documentation of one’s own experience teaching Qigong where you served as the primary teacher. Note: A minimum of two years teaching experience is required for Level II Certification.
Please provide the year, course or form taught, location and the approximate frequency of your teaching.   (Example: 2008 | Five Elements Training | Qigong Institute | Weekly)
Total Teaching Experience: Please enter the total length of time (years and months).
Note: A minimum of two years teaching experience is required for Level II NQA Certification.
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 NQA Certified Senior Level IV Teacher (You will need to ask your teacher if they are in fact a NQA Certified Senior Level IV Teacher)

YesNo
2. If yes, provide the name of your NQA Certified Senior Level IV Teacher. If no, provide 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 validates the number of hours of relevant instruction, a general description of coursework, and descriptive comments about the student’s ability. Hours of experience must still be listed on this application. Please have your NQA Certified Senior Teacher send this letter directly to the NQA office at certification.liason@nqa.org
3.In what year did you begin practicing Qigong? Please describe the style when you first began your practice and the styles you currently practice.
4. In your own words, how would you describe Qigong?
5. How would you explain the basic principles of Jing, Qi, and Shen?
6. What do you feel the role of mind/intention is in Qigong practice?
7. Are you currently teaching Qigong? If yes, when did you begin teaching Qigong? (month/year)
8. What is you current teaching schedule?
9. In addition to Qigong, what other related subjects do you teach?
10. What types/styles of Qigong do you teach and why?
11. How do you begin and end your class to be most effective?
12. When did you begin writing articles, books, or published papers about Qigong?(Please skip this question if it doesn’t apply to you)
13. Have you ever been denied a professional license/certification or had one revoked? If “yes”, please explain briefly.
14. Have you ever been convicted of a crime? 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.liaison@nqa.org.

A. Reference Letter from your Primary Qigong Teacher

This reference is asked to describe the Qigong Training Hours you documented in the 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
- A brief description of why the reference recommends you
C. Reference to Personal Character

This reference should include:
- How the reference knows you
- How long the reference has known you
(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.)

Please list the individuals from whom the Certification Committee should expect to receive letters of reference below:
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*

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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$0.00

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Qigong Instructor Level II Application Form

Contact Info

Qualifications for Qigong Instructor Level II Certification

Formal Qigong Training Hours (FQT)

Virtual (Real-Time) Qigong Training Hours (VQT)

Health Focused Tai Chi Training Hours (HFTC)

Health Focused Kung Fu Training Hours (HFKF)

Related Qigong Training Hours (RQT)

Asynchronous Learning Hours (AL)

Teaching Experience

Questions

Attestation