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CHI Health Institute
New Applicant/Form/Level Information

To be completed after one has been approved by a
Senior or Master Instructor

For certification process please contact

The CHI Health Institute at chihealth.org@gmail.com

Please also read Information page under Certifications tab in the menu

New Applicant/Form/Level Certification

Instructor/Practitioner

Check all the apply*

I am a certified CHI Instructor

I am a certified Feng Shui Consultant

I am a certified ITMI Guide

I am a certified InfiniChi Practitioner

I am a certified PATH Life Coach

I am a new applicant

I understand that the contact information given is for internal use by the College of Tao (COT). for the COT website directory I prefer the following. Please choose one.

Preferences*

I choose to have my name and email in the directory

I choose to have only my name in the directory

I choose to not have my name in the directory

First name*

Last name*

Email*

Country/Region*

Address*

City*

Zip / Postal code*

Phone

Please select your certifications. The letter L denotes different levels. When completing the form checking the highest level Instructor includes all of the previous levels. I.e. checking Master Instructor includes all the previous levels.

Cosmic Tour Bagua

L1: Merry Go Round

L2: Transformations 1 - 4

L3: Transformations 5 - 8

Senior Instructor

Master Instructor

Crane Style Chi Gong

L1: Certified Instructor

Senior Instructor

Master Instructor

Dao In

L1: Short Form

L2: Intermediate From

L3: Long Form

Senior Instructor

Master Instructor

The Eight Treasures

L1: Short Form

L2: Treasures 1 - 4

L3: Treasures 5 - 8

Senior Instructor

Master Instructor

Feng Shui

Certified Consultant

Harmony Tai Chi

L1: Short Form

L2: Intermediate From

L3: Yin Section (58 Step)

L4: Yang Section (50 Step)

Senior Instructor

Master Instructor

Harmony Tai Chi Fan

L1: Short Form

L2: Long Form

L3: Senior Instructor

L4: Master Instructor

Harmony Tai Chi Sphere

L1: Short Form

L2: Long Form

L3: Senior Instructor

L4: Master Instructor

Harmony Tai Chi Staff

L1: Short Form

L2: Long Form

L3: Senior Instructor

L4: Master Instructor

Harmony Tai Chi Straight Sword

L1: Short Form

L2: Long Form

L3: Senior Instructor

L4: Master Instructor

InfiniChi Energy Healing

Certified Practitioner

ITMI Guide

L1 Guide

L2 Guide

L3 Guide

L4 Guide

L5 Guide

PATH LIfe Coaching

Certified Coach

Qi Gong for Cancer Support

L1: Certified Instructor

L2: Senior Instructor

L3: Master Instructor

Qi Gong for Weight Wellness

L1: Certified Instructor

L2: Senior Instructor

L3: Master Instructor

Self Healing Qi Gong

L1: Certified Instructor

Senior Instructor

Master Instructor

Certification Checklist*

I have completed Entering the Tao Course

I have paid the Instructor Training Intensive fee ($80)

I have paid the Instructor exam fee ($50)

I will pay the Application fee after completing this form ($85)

For YSU Students fee schedule please check information page or contact the College of Tao

CONFIRMATION:

I hereby confirm that the foregoing information, and all attachments if any, are true and correct. I agree to provide supporting documentation, when requested. As a Mentor, Certified Instructor, or Practitioner, I will conduct my personal and professional activities in accordance with the highest moral and ethical standards. I understand that COT requests a voluntary 5% yearly donation from my teaching income (after expenses) payable to the College of Tao. I also understand that I m

Date *

After submitting form you will be taken to payment area

CHI New Applicant/Level/Form

$85CHI New Applicant/Level/Form