The Psychological Resources Center (PSYCENTER) requires all first time buyers to provide evidence of their professional qualification to use psychological tests materials. Please fill in the information requested below. Read carefully the Acceptance of Responsibility clause and sign the form to indicate acceptance in the proper use of the materials.

Identification Information (Please print or type)Name _______________________________________________________ Company Employer

____________________________________________Phone _______________________ Email_________________________ Phone _______________________ Fax _________________________Position _____________________________________________________ Supervisor ___________________________________________________

_____________________________________________________________ _____________________________________________________________A. Appropriate Training in the Use of Tests

1. Level of training (Please check.):

Doctoral Year Institution Field of Study

Masters Degree Year Institution Field of Study

Bachelor’s Degree Year Institution Field of Study

2. Areas of Expertise (Please check appropriate boxes)

Clinical/Mental Health Special Education Occupational Therapy

Psychiatry Career and Vocational Training Rehabilitation

School Psychology Personal Speech/Language/Hearing

Marriage & Family Counseling Others: __________________

3. Courses (Please check boxes.):

Basic Tests and Measurement Assessment course in major field

Descriptive Statistics Use in Test Counseling

Intelligence/cognitive Testing Career Assessment

Speech, hearing, language assessment Education Diagnostics

Projective techniques Neuropsychological assessment

Others (Please List.) ____________________________

4. Other Study (Please check boxes.):

Practicum in test Administration Internship (school psychology/counseling)

Attending workshop/seminars (Please specify.) _________________________

B. Acceptance of Responsibility for the Use of Tests

Professional use of educational and psychological tests measure that all tests users must: Maintain the security of testing materials before and after testing. Administer, score, interpret and use tests exactly as specified in the manual. Release results only to authorized persons and in form of keeping with accepted principles of tests interpretation. Adhere strictly to the COPYRIGHT LAW and under no circumstances photocopy or otherwise reproduce answer forms, test booklets,

or manuals.

I certify that I have the appropriate training and competence to administer, score and interpret the test materials being purchased. I assume full responsibility for the proper use of the testing materials I order from PSYCENTER. I affix my signature to indicate acceptance of and compliance with the above principles.

_____________________________ ____________________________ Signature over Printed Name Date

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Psychological Resources CenterNurturing Minds… Enhancing Lives…

Unit 2F-A FSS Building 89 Scout Castor Street Roces Avenue Brgy Laging Handa Quezon CityPhone: (02) 415-6997 to 4156998 email:psycenter2002@yahoo.com

QUALIFICATION/ACCEPTANCE OF RESPONSIBILITY FORM

Membership ID Form

Name: «[

Birthday: «[

Contact No: «[

Address: «[

Position: «[

Signature: «[

Qualification Level: «[ (please leve blank

Note: Please attach your picture 2x2

GUIDELINES FOR ACCREDITATION

1. APPLICATION FORM. A client who wants to purchase psychological testing materials or avail of testing services from PSYCENTER either for his/her own use or for use of the company/school he represents shall have to fill-up an application form to qualify. The client is required to submit the filled-up application form together with her/his resume, and the following documents:

Photocopy of Transcript of Records 2 pcs. 1 x 1 I.D. pictures Certificate of Employment Php 250 for Membership ID (valid for 3 years)

2. PSYCENTER shall evaluate the client's qualification based on the application form and resume submitted and shall classify the client as to levels for which he/she can avail of certain test materials. The following classification levels shall apply with the corresponding test materials that the clients are qualified to purchase:

A - I.Q. / E.Q. Personality Inventory

B - Personality Disorders InventoryBusiness / Industry Light Projective Tests ( including A )

C - Projective Tests ( including A & B )

3. IN HOUSE TRAINING CONSULTATION. PSYCENTER shall upon request of clients, provide one-on-one or small group training/consultation to qualified clients in areas of test administration, interpretation and psychological analysis report writing and other related areas.

4. SEMINAR / WORKSHOP. PSYCENTER shall sponsor seminar/workshops at least once a year on Psychology testing related topics. These seminar/workshops are open to-all clients as well as other interested parties and individuals. Certificates of attendance shall be given to participants who have completed the workshops. For accredited clients, these seminar/workshops shall be credited to their qualifications on record and may upgrade their qualification levels. (e.g. from level A to level B)

5. FREQUENT PURCHASE INCENTIVES. Accredited clients who have impressive tract records of purchases shall get incentives in kind, proportionate to the total amount of their purchase. The client has the option to donate the incentive to the institution that they represent.

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