Tai Ji Quan: Moving for Better Balance® Instructor Training Application

The New Mexico Department of Health, Office of Injury Prevention, in partnership with the Oregon Research Institute, is sponsoring a 2-day instructor training for the evidence-based falls prevention program, Tai Ji Quan: Moving for Better Balance®. This course is for NEW instructors only. If you have been trained in "Tai Ji Quan" in the past and would like a refresher course, please watch for notification of a Spring 2017 refresher training.

About the Training:
· Dates: November 12 & 13, 2016 (Saturday & Sunday)
· Times: 8:00 am – 5:00 pm both days
· Location: Manzano del Sol Village, 5201 Roma Ave NE, Albuquerque, NM 87108
· Cost: Training is FREE – no training or materials fees
· Meals: Trainees may bring a sack lunch, or purchase lunch on their own (several options nearby, cafeteria on-site)
· Materials Provided: Workbook, program users guide, DVD, and research articles
· Clothing: Wear comfortable, light, cotton exercise clothing
· Maximum Class Size: Training capacity is limited to 15 trainees
· CEUs: At this time, CEUs are NOT available for this training
· Differently-Abled Trainees: If you require accommodations to participate in the training, please contact Karen Dugas, Adult Falls Prevention Coordinator, New Mexico Department of Health: karen.dugas@state.nm.us or 505-827-5146

How to Apply:
· Training Application Form: Please fill out this application form (below) IN FULL. Incomplete applications will not be considered.
· Training Application Deadline: Friday, November 4, 2016.
· Selection: Due to class size limitation, submission of your application does NOT automatically equal selection to participate in the Fall 2016 training. Selected participants will be notified by Monday, November 7, 2016.

Requirements:
Applicants MUST:
· Be available for the entire 2-day training – those who must arrive late or leave early due to scheduling conflicts will not be considered.
· Be willing to fulfill the Instructor Expectations listed below (after Question 3).
· Provide proof of an arrangement for a class location (i.e., copy of a rental or usage agreement, email or letter from a senior center, community center, faith-based organization, or other site – at no cost or for a rental fee paid by the instructor) for their “Tai Ji Quan” class, to be held within 6 months after training. This proof is required so that the applicant can demonstrate the ability to provide their first class in a timely manner after the instructor training to maintain fidelity to the program model.

Applicant Selection:
Selections will be based on the following criteria:
· Complete applications submitted by deadline
· Ability to attend the entire 2-day training and commit to Instructor Expectations (see below, after Question 3)
· Proof of arrangement for a class location (copy of email, letter, signed rental agreement, etc)
· Geographic diversity and/or geographic area of need – an area with a high rate of death from falls among older adults
· Well-designed plans to recruit students and make classes affordable

Question Title

* 1. Contact Information

Tai Ji Quan: Moving for Better Balance Instructor Expectations:

1. Conduct at least one "Tai Ji Quan: Moving for Better Balance" class to be held for 60 minutes per session, 2-3 sessions per week, for a minimum of 4 consecutive months (6 months preferred), with a start date within 6 months of your training. 
2. Communicate at least quarterly with the NMDOH Adult Falls Prevention Program Coordinator regarding class size, student attendance, changes in student's performance over time, and other class progress and program evaluation data.
3. Make every effort to maintain fidelity to the program model by using the knowledge and skills gained in the instructor training as they were taught (protocol and routine) and according to the teaching option guidelines.
Teaching Options for Classes:
A.  A 60-minute-per-session class conducted three times per week for 4 months minimum (preferred).
B.  A 60-minute-per-session class conducted twice per week, with an additional 45-min required home practice for 6 months minimum.
C.  A 90-minute-per-session class conducted two times per week for 4 months minimum.

Important note: Fidelity to the program model ensures that the program is providing the evidence-based health benefit to older adults, in turn reducing and preventing injury and death from falls. 

Question Title

* 8. Student Recruitment Plan: Please state how you will recruit students to attend your class (email, flyers, social media, host site's newsletter, other):

Question Title

* 9. Affordability Plan: Please state how you plan to make your class affordable and accessible to older adults, many of whom live on a fixed income:

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* 10. Sustainability Plan: Please state how you plan to sustain your classes past the initial offering between December 1, 2016 - May 31, 2017. For example, you may consider in-kind support, staff time, training space, partnerships with groups or organizations in the community, use of copiers/printers or other equipment, ongoing recruitment, etc:

Other Information:

Travel Scholarships: Trainees who are traveling 50 miles or more one way to attend the training may apply for a travel and lodging scholarship.
• Scholarship Terms: Trainees selected for travel scholarships will be reimbursed at the State of NM rate of $0.46/mile and up to $95/night lodging, including taxes (reimbursement is limited to the cost of the lodging ONLY; food, alcohol or other amenities charged to the room will NOT be reimbursed).
• To Apply: Please (1) ensure you have completed this Training Application Form IN FULL; and (2) complete a travel scholarship application form IN FULL. Only fully completed scholarship applications with fully completed training applications will be considered.
• Travel Scholarship Deadline: Applications must be completed and submitted IN FULL by Friday, November 4, 2016.
· Applicants will be notified by Monday, November 7, 2016.

Waiting List: Applicants not selected for the Fall 2016 training, but who have a fully completed application submitted by deadline and with proof of a class location arrangement, will be put on the Waiting List.
• If any accepted applicants cancel prior to the Fall 2016 training, applicants on the Waiting List will be contacted and offered the open spot.
• Any applicants on the Waiting List who are not selected to attend the Fall 2016 training will be prioritized in consideration for future trainings. NMDOH anticipates continuing this training program until further notice.

Questions: For questions, please contact Karen Dugas, Adult Falls Prevention Coordinator, New Mexico Department of Health: karen.dugas@state.nm.us or 505-827-5146.

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