SCORING : USER QUALIFICATION FORM

User Qualification Form
 
GENERAL INFORMATION
*indicates a required field
Name*
Title
Organization
Street Address*
City*
State*
ZIP*
Phone Number*
FAX Number*
eMail*
Verify eMail*
   
EDUCATION
Degree* Major Field*
College/University* Year*
Degree Major Field
College/University Year
   
LICENSES / CERTIFICATION
Area*
State* Number* Exp.*
Area
State Number Exp.
           
DESCRIPTION OF QUALIFICATION CATEGORIES
Psychologist licensed to practice on an independent basis by the licensing board in the state(s) in which you currently practice, may interpret A, A1, B1, B2 and or C level tests.
Member of the American Association of Counseling and Development (AACD) wishing to purchase only A1, B2 and/or C level services and who does not need to be supervised in the use of the materials and services which one anticipates ordering because of legal, ethical, or other considerations.
Licensed marriage and family counselor wishing to purchase B1, B2 and/or C level services and who does not need to be supervised in the use of the materials and services which one anticipates ordering because of legal, ethical, or other considerations.
Licensed physician wishing to purchase only B1, B2 and/or C level services and who does not need to be supervised in the use of the materials and services which one anticipates ordering because of legal, ethical, or other considerations.
Member of the American Education Research Association (AERA) wishing to purchase on B2 and/or C level tests and materials and who does not need to be supervised in the use of the materials and services which one anticipates ordering because of legal, ethical, or other considerations.
School/College/University official wishing to purchase only B2 and/or C level tests and materials and who does not need to be supervised in the use of the materials and services which one anticipates ordering because of legal, ethical, or other considerations.
Professional who does not automatically qualify for tests and services.
 
OCTS
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