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Zip / Postal code:
94501
94502
94536
94537
94538
94539
94546
94550
94551
94552
94555
94566
94568
94580
94586
94588
94601
94602
94603
94604
94605
94606
94607
94608
94609
94610
94611
94612
94613
94614
94615
94617
94618
94619
94620
94621
94622
94623
94624
94649
94661
94662
94666
94701
94702
94703
94704
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*
Phone:
*
customer qualifications
In which country did you receive your education and/or professional training?
-- Select Country --
United States
Afghanistan
Albania
Algeria
Angola
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Bermuda
Bhutan
Bolivia
Botswana
Brazil
Bulgaria
Burundi
Cambodia
Canada
Cape Verde
Chad
Chile
China
Christmas Island
Colombia
Comoros
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
France
Gabon
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guinea
Guyana
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Lebanon
Lesotho
Liberia
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Mauritania
Mauritius
Mexico
Mongolia
Morocco
Mozambique
Myanmar
Namibia
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Palau
Panama
Paraguay
Peru
Philippines
Poland
Qatar
Romania
Russia
Rwanda
Samoa
San Marino
Saudi Arabia
Senegal
Serbia
Singapore
Slovenia
Somalia
South Africa
South Korea
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tunisia
Turkey
Turkmenistan
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Venezuela
Yemen
Zambia
Zimbabwe
*
What is the highest educational degree that you have obtained (select one)?
-- Select Educational Degree --
Advanced Certificate
Associate Degree
Bachelor’s Degree (4-Year College or University)
Doctorate
Graduate Certificate
High School Diploma or GED
Master’s Degree
Other
*
Other Education Degree:
*
Field of Study:
-- Select Field of Study --
Biblical Studies
Business
Career Guidance
Christian Education
Counseling
Divinity
Education
Human Resources
Human Services
Medicine
Mental Health
Ministry
Nursing
Occupational Therapy
Organizational Behavior
Other
Pastoral Counseling
Psychiatry
Psychology
Public Health
Rehabilitation Studies
Religion
Social Science
Social Work
Substance Abuse
Theology
*
Other Field of Study:
*
Year of Degree Completion:
-- Select Year --
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
*
Institution Name:
*
Are you currently a Graduate/Undergraduate Student?
Yes
No
*
Name of Supervising Professor:
Graduate Field of Study:
-- Select Field of Study --
Biblical Studies
Business
Career Guidance
Christian Education
Counseling
Divinity
Education
Human Resources
Human Services
Medicine
Mental Health
Ministry
Nursing
Occupational Therapy
Organizational Behavior
Other
Pastoral Counseling
Psychiatry
Psychology
Public Health
Rehabilitation Studies
Religion
Social Science
Social Work
Substance Abuse
Theology
*
Projected Year of Graduation:
-- Select Year --
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
*
Professional licenses or certifications
-- Select Professional licenses/certifications --
Certified Educational Diagnostician
Certified Psychometrist
Certified Teacher
Licensed Clinical Social Worker
Licensed Marriage and Family Therapist
Licensed Medical Doctor
Licensed Mental Health Counselor
Licensed Nurse/Nurse Practitioner
Licensed Professional Counselor
Licensed Psychiatrist
Licensed Psychological Associate
Licensed Psychological Examiner
Licensed Psychologist
Licensed Rehabilitation Specialist
Licensed School Counselor
Licensed School Psychologist
Licensed Vocational Evaluator
Licensed/Certified Occupational Therapist
Nationally Certified Counselor
Nationally Certified School Counselor
Clear your selection
*
*
*
-- Select Professional licenses/certifications --
Certified Educational Diagnostician
Certified Psychometrist
Certified Teacher
Licensed Clinical Social Worker
Licensed Marriage and Family Therapist
Licensed Medical Doctor
Licensed Mental Health Counselor
Licensed Nurse/Nurse Practitioner
Licensed Professional Counselor
Licensed Psychiatrist
Licensed Psychological Associate
Licensed Psychological Examiner
Licensed Psychologist
Licensed Rehabilitation Specialist
Licensed School Counselor
Licensed School Psychologist
Licensed Vocational Evaluator
Licensed/Certified Occupational Therapist
Nationally Certified Counselor
Nationally Certified School Counselor
*
*
*
Professional organizations to which you belong
-- Select Professional Organization --
American Board of Professional Psychology (ABPP)
American Counseling Association (ACA)
American Educational Research Association (AERA)
American Medical Association (AMA)
American Occupational Therapy Association (AOTA)
American Psychological Association (APA)
American Psychological Society (APS)
International Neuropsychological Society (INS)
National Academy of Neuropsychology (NAN)
National Association for the Education of Young Children (NAEYC)
National Association of School Psychologists (NASP)
National Board of Certified Counselors (NBCC)
National Career Development Association (NCDA)
National Career Development Association (NCDA) Career Counselor
National Career Development Association (NCDA) Career Specialist
National Register of Health Service Psychologists
Clear your selection
*
-- Select Professional Organization --
American Board of Professional Psychology (ABPP)
American Counseling Association (ACA)
American Educational Research Association (AERA)
American Medical Association (AMA)
American Occupational Therapy Association (AOTA)
American Psychological Association (APA)
American Psychological Society (APS)
International Neuropsychological Society (INS)
National Academy of Neuropsychology (NAN)
National Association for the Education of Young Children (NAEYC)
National Association of School Psychologists (NASP)
National Board of Certified Counselors (NBCC)
National Career Development Association (NCDA)
National Career Development Association (NCDA) Career Counselor
National Career Development Association (NCDA) Career Specialist
National Register of Health Service Psychologists
*
*
Did you complete coursework in any of the following areas at the undergraduate/graduate level while attending a college/university?
Assessment of Psychopathology
Career Assessment
Cognitive Assessment
Descriptive Statistics
Neuropsychological Assessment
Personality Assessment
Projective Assessment
Test and Measurement Theory
Test Interpretation
Use of Tests in Counseling
Have you participated in a T-JTA training seminar, workshop, or course?
Yes
No
*
training details
Year of Training:
-- Select Year --
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
*
Country
-- Select Country --
United States
Afghanistan
Albania
Algeria
Angola
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Bermuda
Bhutan
Bolivia
Botswana
Brazil
Bulgaria
Burundi
Cambodia
Canada
Cape Verde
Chad
Chile
China
Christmas Island
Colombia
Comoros
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
France
Gabon
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guinea
Guyana
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Lebanon
Lesotho
Liberia
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Mauritania
Mauritius
Mexico
Mongolia
Morocco
Mozambique
Myanmar
Namibia
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Palau
Panama
Paraguay
Peru
Philippines
Poland
Qatar
Romania
Russia
Rwanda
Samoa
San Marino
Saudi Arabia
Senegal
Serbia
Singapore
Slovenia
Somalia
South Africa
South Korea
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tunisia
Turkey
Turkmenistan
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Venezuela
Yemen
Zambia
Zimbabwe
*
Instructor:
-- Select Instructor --
*
Name of Instructor:
*
Did you obtain a Counselor’s Kit from this trainer?
Yes
No
Type of Kit:
-- Select Type Of Kit --
Online Scoring Kit
Handscoring Kit
Mail-in/Fax-in Scoring Kit
Software Scoring Kit
*
Kit Serial Number:
*
?
Note: We recognize that educational and licensing requirements for the use of psychological tests vary around the world. If your educational background and/or training experience do not fit the above criteria, please use the box below to provide additional information about your educational/professional experience in the use of tests. We will make every effort to evaluate your qualifications in an equitable and appropriate manner.
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