Provisional Certification Application Survey

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Provisional Certification Application

Provisional Certification allows practitioners to use the FGNA service marks (as specified in FGNA Policy) while completing the requirements for professional experience and Continuing Competence.

To apply for provisional certification, you must:
1. Complete at least ten hours of learning;
2. Agree to complete the remainder of the required hours before provisional certification expires;
3. Complete a self-assessment and write a Continuing Competence Plan, per the requirements of FGNA Policy E2.3.1.2 Continuing Competence.
4. Agree to comply with the following FGNA policies:

“E2.3.2.1 The Feldenkrais Method® of Somatic Education Standards of Practice”;
“E2.3.3.2 Code of Professional Conduct”; and
“E2.4.2.1-ED FGNA Service Marks, Certification Marks and Trademarks”;

5. Complete the Application for Provisional Certification and the applicable Membership or Certification Form; and
6. Pay the applicable fees.

Practitioners who have not previously received certification from FGNA also need to provide information about the training program they completed.

Please indicate which of the following Requirements you meet*

	yes	no
1. I have completed at least ten hours of learning.
2. I agree to complete the remainder of the required hours before provisional certification expires;
3. I have completed a self-assessment and written a Continuing Competence Plan, per the requirements of FGNA Policy E2.3.1.2 Continuing Competence.
4. a. I agree to comply FGNA policy “E2.3.2.1 The Feldenkrais Method® of Somatic Education Standards of Practice”
4. b. I agree to comply FGNA policy “E2.3.3.2 Code of Professional Conduct”;
4. c. I agree to comply FGNA policy “E2.4.2.1-ED FGNA Service Marks, Certification Marks and Trademarks”;
5. I have completed the applicable Membership or Certification Form

Certification from FGNA:*

		yes		no
I have already received certification from FGNA and thus am not submitting Documentation of Graduation.

If you have not been previously certified by FGNA, please provide the following information
(*Training must be accredited by NATAB, AusTAB, or EuroTAB)

Name of Graduate:
Name of Training Program*
Location of Training
Graduation Date

Your name and contact information:*

Name:
Telephone:
Cellphone:
email address: