RE-QUALIFICATION APPLICATION

Dear Polestar Graduates,
Polestar’s certifications/qualifications are valid for two years, after which time re-qualification is required. It is
important that we maintain high standards in the Pilates industry. Polestar Pilates Education continues to improveand develop its curriculum and examination process. Like most high-quality education programs, re-qualification
is an essential part of maintaining skills and quality of care.
Included in this package is a fact sheet, application, and payment form. Students from who graduated from an Asia Hostwill turn in their application to Polestar Pilates Asia Inc. When your application is approved you will receive a newcertificate valid for another two years.
Please pay attention to the due dates to avoid any late fees and to expedite receipt of your new certificate. If yourapplication is submitted more than 6 months after the due date (November of the requalification year), it might benecessary for you to fulfill certain obligations such as re taking of the exam or attending an update course, before
your application will be considered. Please feel free to contact Polestar Headquarters or your licensee regarding
this process.
As you know, Polestar has continued to raise the bar in all of our education products. We thank you for yourfeedback on how we can continue to make our curriculum better.
Sincerely,Brent D. Anderson, PhD, PT, OCS
President

Polestar Education supports the national Pilates certification examination established in 2005 through the Pilates Method Alliance (PMA), which will
standardize the quality of Pilates practice. As a result, in the United States, Polestar will grant a diploma to students meeting graduation requirements.
Polestar graduates will be eligible to sit for the national certification exam through the PMA. For details on the PMA's certification exam, please visit
www.pilatesmethodalliance.org.
As there is not yet a standard international certification examination, we will continue to offer certification exams for participants in non-US countries.
Polestar Education will regard Polestar US students who have completed all graduation requirements as having gained the same qualification as
someone certified internationally through Polestar Education.

Polestar Pilates Education
305.666.0037
Address 1500 Monza Ave Suite 350 Coral Gables, FL 33146 Phone 800.387.3651
Fax 305.666.1808 E-mail education@polestarpilates.com Website www.polestarpilates.com®

Polestar is a registered trademark of Polestar Education LLC
Oct 2010

Page 1 of 5

Polestar Pilates Asia
802-805, 8/F, Yu Yuet Lai Building, 43-55 Wyndham St, Central, Hong Kong
Phone: +852-2869-8630
Fax: +852-2869-6903
E-mail: info@polestarpilatesasia.com Website: www.polestarpilatesasia.com

RE-QUALIFICATION APPLICATION

Polestar Pilates Education continues to improve and develop its curriculum and examination process. Like most high-quality education programs,
re-qualification is an essential part of maintaining skills and quality of care. Polestar’s certifications are valid for two years, after which time re-qualificationis required.

REHABILITATION AND STUDIO PRACTITIONERS RE-QUALIFICATION REQUIREMENTS
In order to re-qualify, Rehabilitation and Studio practitioners must:
1.
2.
3.
4.

EITHER
Maintain their PMA ®-CPT Credential.
OR
Teach Pilates or use Pilates as treatment 10-15 hours per week (minimum 1040 hours over a 2-year period);
Practice Pilates at least 2 hours per week;
Earn 16 Polestar CEC’s over a 2-year period.

REFORMER (ALLEGRO) AND MAT PRACTITIONERS RE-QUALIFICATION REQUIREMENTS
In order to re-qualify Reformer (Allegro) and Mat practitioners must:
1.
2.
3.

Reformer (Allegro) and Mat Practitioners are required to teach 2-3 classes per week (minimum 208 hours over a 2-year period);
Practice Pilates at least 2 hours per week;
Earn 16 Polestar CEC’s over a 2-year period.

Polestar Pilates Education
305.666.0037
Address 1500 Monza Ave Suite 350 Coral Gables, FL 33146 Phone 800.387.3651
Fax 305.666.1808 E-mail education@polestarpilates.com Website www.polestarpilates.com®

Polestar is a registered trademark of Polestar Education LLC
Oct 2010

Page 2 of 5

Polestar Pilates Asia
802-805, 8/F, Yu Yuet Lai Building, 43-55 Wyndham St, Central, Hong Kong
Phone: +852-2869-8630
Fax: +852-2869-6903
E-mail: info@polestarpilatesasia.com Website: www.polestarpilatesasia.com

ｚ

For PPA office use only:
Received:
Please submit a separate application for each qualification.
（更新対象の資格ごとに申請書をご提出ください。）

RE-QUALIFICATION APPLICATION（資格更新申請）

Approved:

Please complete and subm it application along with payment for re-qualification. PLEASE WRITE CLEARLY IN ENGLISH. COMPLETE ALL FIELDS. MARK [X] AS NEEDED（ご記入の上、資格更新料と合わせてご提出ください。英語ではっきりとお書きください。すべての欄にご記入願います。選ぶ必要のある箇所は該当する□に×印を）Mr / Ms

Student Number:（生徒番号）〇〇〇〇 First Name:（名）Taro

Last Name:（姓） Kuramae

Name as it will appear on Certificate:名前（認定証にはこれに従って表記されます） TARO KURAMAE
Home Address:（住所） Kuramae 〇-〇-〇

City/Town:（市町村）Taito

Postal Code:（郵便番号）〇〇〇-〇〇〇〇 Country:（国名） Japan

Phone (Country Code - City Code - Number):電話番号（国番号-市外局番-番号）

Phone (Country Code - City Code - Number): 電話番号（国番号-市外局番-番号）

81-〇〇－〇〇〇〇－〇〇〇〇

State/Province:（都道府県） Tokyo

E mail:（メールアドレス）〇〇＠〇〇〇〇

Qualification（更新対象の資格）（該当するものに×印）

 Rehab（リハビリ）  Studio（スタジオ）  Reformer (Allegro) リフォーマー（アレグロ）  Mat（マット）
Qualification Date (mm/yy)資格取得日（月/年） 〇〇 / 〇〇〇〇
Pilates Teaching Record（ピラティス指導の記録）
1ST YEAR AFTER QUALIFICATION DATE - WEEKLY SUMMARY （資格取得後１年目- １週間の指導概要）
Studio/Site Name
（スタジオ/会場名）

Site Address (City, Sate, Zip)
住所（市、県、郵便番号）

Site Phone Number（電話番号）

STUDIO 〇〇Kuramae 〇-〇-〇 Taito, Tokyo 111-0051

Supervisor's Name
（責任者名）

Average Weekly Hours x Wks/Yr（週の平均時間数×１
年の週数）

10h x 52wkx

TOTAL Hours perYear（1年間の総時間数）

=520h
=x
=
資格により必要時間が異なりまx=すのでご注意ください。

2ND YEAR AFTER QUALIFICATION DATE - WEEKLY SUMMARY（資格取得後２年目- １週間の指導概要）
Studio/Site Name
（スタジオ/会場名）

Site Address (City, Sate, Zip)
住所（市、県、郵便番号）

Site Phone Number（電話番号）〇〇Hospital

Nishinakasima〇-〇〇-〇, Yodogawa,Osaka 532-0011

Supervisor's Name
（責任者名）

Average Weekly Hours xWks/Yr（週の平均時間数×１年の週数）

10h x 52w
k

電話番号、責任者名は可能な範囲でご記入ください。

®

Polestar is a registered trademark of Polestar Education LLC
Oct 2010

Page 3 of 5=520h

x

=x

=x

2-YEAR TOTAL（2年間の合計時間数）

Polestar Pilates Education
305.666.0037
Address 1500 Monza Ave Suite 350 Coral Gables, FL 33146 Phone 800.387.3651
Fax 305.666.1808 E-mail education@polestarpilates.com Website www.polestarpilates.com

TOTAL Hours per
Year (1年間の総時間数)==1040h

Polestar Pilates Asia
802-805, 8/F, Yu Yuet Lai Building, 43-55 Wyndham St, Central, Hong Kong
Phone: +852-2869-8630
Fax: +852-2869-6903
E-mail: info@polestarpilatesasia.com Website: www.polestarpilatesasia.com

RE-QUALIFICATION APPLICATION（資格更新申請）CONTINUING EDUCATION: TWO YEAR SUMMARY (PLEASE ATTACH COPIES OF ALL CERTIFICATES OF ACTIVITES L ISTED BELOW)
継続教育：５年間の概要（下記の活動のすべての認定証のコピーを添付してください。）
Date
（日付）

Workshop/Course/Conference（ワークショップ/コース/カンファレンス）Location（場所）

Provider（提供者名）

Total Hours（総時間数）

Polestar CECs
（ポールスターCEC単位数）例）Feb3-4, 2018例）Polestar Pilates WinterSeminar 2019 in Tokyo

Tokyo〇〇〇〇,〇〇〇〇

16ｈ

16CEC

セミナー詳細はHPの「過去のセミナー」をご参照ください。
参加時の認定証が見つからない場合や取得CECの確認が必要な場合は、直接PPAにお問い合わせください。

TOTAL CONTINUING EDUCATION CREDITS

Please use an additional sheet of paper if more space is needed（スペースが足りない場合は用紙を足してください）（継続教育単位CEC合計）

Polestar Pilates Education
305.666.0037
Address 1500 Monza Ave Suite 350 Coral Gables, FL 33146 Phone 800.387.3651
Fax 305.666.1808 E-mail education@polestarpilates.com Website www.polestarpilates.com®

Polestar is a registered trademark of Polestar Education LLC
Oct 2010

Page 4 of 5

=16CEC

Polestar Pilates Asia
802-805, 8/F, Yu Yuet Lai Building, 43-55 Wyndham St, Central, Hong Kong
Phone: +852-2869-8630
Fax: +852-2869-6903
E-mail: info@polestarpilatesasia.com Website: www.polestarpilatesasia.com

Instructions for Submission of Application（申請書提出の方法）
1.

Complete the Re-Qualification Application（資格更新申請書をすべてご記入ください）2.

Complete the billing and credit card information (see below)（支払い明細およびクレジットカード情報（下記）をすべてご記入ください）3.

Copy your continuing education certificates or receipts for each course/workshop attended（継続教育で出席したコース/ワークショップの認定証もしくは領収書のコピーをご用意ください）

4.

Mail completed application, credit card information and copies to Polestar Pilates Asia.
（すべて記入された申請書、クレジットカード情報、認定書もしくは領収書のコピーをPolestar Pilates Asia宛にご郵送、またはメール添付してください）

NOTE: Missing, incomplete or inaccurate information will result in delay of processing or possible rejection of application.
（注意：書類の不備、記入漏れ、記入間違いがありますと、処理に遅れが生じたり申請を受理できない場合もあります）
RE-QUALIFICATION DEADLINES AND FEES（各更新内容・料金）

USD$75.00 fee for applications received by November 1 of re-qualification year (The year you passed your exam + 2yrs)（更新年（合格した年＋2年）の11月１日までに更新申請が受理される場合の更新料：75米ドル）
USD$150 fee for applications received after November 2 of the re qualification year – April 30 of the following year.
（更新年（合格した年＋2年）の11月2日から翌年4月30日までに更新申請が受理される場合の更新料：150米ドル）
Payment Instructions（お支払い方法）:
PLEASE PRINT CLEARLY（はっきりと記入してください）: COMPLETE, SIGN AND FAX TO: +852-2869-6903 TO: ISOFIT-ON BEHALF OF POLESTAR PILATES ASIA INC.
PLEASE DEBIT MY CREDIT CARD (MASTER/VISA ONLY)（この金額を私のクレジットカードから引き落としてください（MASTERもしくはVISAに限ります）金額： US$75

IN WORDS（次の欄には金額を英語で書いてください。75米ドルであればSEVENTY-FIVE、150米ドルであればONE HUNDRED FIFTY）:
金額： US$SEVENTY-FIVE_[ ]SVRIS
使ー用ルすスるタクーレピ
ジラッテトカドの]につ）けてください）
F[ O
TARDPILATEEA-QUALIFICATION（（ポィース資格[更新×料印とをして]R
M:APSOTLEERSCMY CREDIT CARD DETAILS ARE AS FOLLOWS（クレジットカード情報）:
CREDIT CARD NUMBER（クレジットカード番号）: 〇〇〇〇 / 〇〇〇〇 /〇〇〇〇 /〇〇〇〇
3 DIGIT SECURITY CODE（カード裏面に記載されている３桁のセキュリティーコード）: 〇〇〇EXPIRY DATE: (MM/YY)（有効期限（月/年）: 〇〇_ _ / 〇〇__NAME ON CREDIT CARD（クレジットカードに記載されている名前）:〇〇〇〇

SIGNATURE AS APPEARS ON CREDIT CARD （クレジットカードに記載されている署名）〇〇〇〇FOR OFFICE USE ONLY
Licensee Signature:Polestar Representative Signature:
New Certificate Sent:

Date

Polestar Pilates Education
305.666.0037
Address 1500 Monza Ave Suite 350 Coral Gables, FL 33146 Phone 800.387.3651
Fax 305.666.1808 E-mail education@polestarpilates.com Website www.polestarpilates.com®

Polestar is a registered trademark of Polestar Education LLC
Oct 2010

Page 5 of 5

Polestar Pilates Asia
802-805, 8/F, Yu Yuet Lai Building, 43-55 Wyndham St, Central, Hong Kong
Phone: +852-2869-8630
Fax: +852-2869-6903
E-mail: info@polestarpilatesasia.com Website: www.polestarpilatesasia.com