Title:
DR
MR
MRS
MS
PAST
REV
First Name:
Last Name:
Home Address #1:
Home Address #2:
Suite:
City:
Province:
Country:
Occupation:
Employer:
Bus. Address #1:
Bus. Address #2:
Suite:
City:
Province:
Country:
Education Summary
Which describes your highest level of education?
Please list All Schools attended, Location, Major, Degree, and year Degree received.
This application captures information for up to three schools. Additional information can be included in the text box at the end of the application, under "Intended Usage."
At least one school and degree must be listed below to submit your application.
Name of College/Seminary/University
City/State
Degree: List the degree you obtained from this school (B.A., M.A. M.Div., Ph.D., etc.)
Year Degree Received
Length of Study
Major Field
Minor Field
Name of College/Seminary/University
City/State
Degree
Year Degree Received
Length of Study
Major Field
Minor Field
Name of College/Seminary/University
City/State
Degree
Year Degree Received
Length of Study
Major Field
Minor Field
Please check each course or workshop you have completed:
Indicate your area(s) of expertise:
Have you had specialized training in marriage, family, or pastoral Counseling?
If yes, Year
Place of Training
Course/Seminar
Have you participated in a T-JTA Training Seminar, or Workshop or course?
If yes, Year
Place of Training
Name of T-JTA Instructor
Did you obtain a T-JTA Counselor's Kit at time of training?
If no, would you be interested in attending a training seminar?
Professional Licenses or Certifications:
Professional Organization to which you belong:
List name of Assessment(s) you are applying to use:
Summary of intended test material usage:
Enter your E-mail address and we will inform you of your application status by E-mail.
I
certify that all of the information contained
in this form is accurate. I certify that I or other persons who may use any test
materials I order have a general knowledge of measurement test principals and of
appropriate and ethical test use and interpretation as called for in the
Standards for Educational and Psychological
Testing.
I certify that I/we are
qualified and agree to use and interpret the results of these tests as
recommended by these standards, and I assume full responsibility for proper use
of the testing materials I order from PPI. I agree not to copy, distribute,
resell, sublicense, export, redistribute, or otherwise transfer for use by any
other person or entity any PPI test materials without specific written
permission, as these activities constitute copyright infringement.. I agree not to resell, sublicense, export, redistribute, or otherwise transfer for use by any other person or entity any copy of the instrument. I also certify that I have read and agree to the PPI's Terms and Conditions and Copyright and Use Agreement
I agree with the above statement
