Sign Up/Qualification

The majority of tests offered by Derogatis Psychological Test Site are selectively available to qualified professionals in accordance with the principles represented in the Ethical Standards for Psychologists published by the American Psychological Association. Eligibility to purchase these instruments is established on the basis of professional training and experience. This form should be completed and submitted.

Some of the information requested below may not be applicable to you, do not respond to those queries.

Your Name (required)

Degree

License Profession

License Number

Organization

Title

Address

City

State

Zip Code

Phone Number *

Activities in which these instruments will be used: (required)
Please describe

If not you, within your organization, who is responsible for supervising the use of these materials?

Name

Title

Academic Training Degree

Year

Institution

Major Field

I hereby certify that I and/or individuals under my supervision possess a knowledge of the basic principles of psychological measurements and of the limitations on valid interpretations as represented in the APA standards for educational and psychological tests. I further certify that I am qualified to utilize the instruments purchased in a manner consistent with APA recommended standards.

Your Email (required)

Date (required)

If a graduate student check here.

Professor/Supervisor: I agree to supervise this student in the use of the test materials ordered.

Professor's Name

Professor's Email

Department

Institution