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PPI Application to Provide Authorized
T-JTA instruction. |
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| Title:
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First Name: |
| Last Name: |
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| Account Number: |
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| Home Address #1: |
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| Home Address #2: |
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| Suite: |
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| City: |
State: |
| Province: |
ZipCode: |
| Country: |
Telephone: |
| Email Address: |
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| My T-JTA training will be offered
in conjunction with a: |
| University
or College |
Seminary |
Church |
Private Organization |
| Military or Gov't Agency |
Other
(Please Describe in Detail |
| If training is to be given at a
school, please indicate the name of the school and its
address. |
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| If training is to be offered under
the name or auspices of an organization other than a school give the
name and address of the organization and its general
purpose. |
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| My T-JTA trainees will fall into
the following categories: |
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Ministers |
Psychologists |
Marriage & Family Counselors |
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Pre-professional student in Psychology, Social Work,
Education> |
| Other, Please specify |
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| I am planning to conduct my first
T-JTA training seminar or course on the following date: |
| Approximate number of participants:
| How many times a year will training
be offered? |
| Describe your intended T-JTA
training course of Seminar: |
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| Please describe your experience
with the T-JTA: |
| Number of years used:
| Approximate number of
administrations: |
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| Please check the edition of the
Test Manual you are using: |
| 1984
Test Manual |
1992 Test Manual |
1996
Test Manual |
2002
Test Manual |
2006
Test Manual |
2007
Test Manual |
| If you have a T-JTA Handbook check
the edition Year: |
| 1984
Handbook |
1992 Handbook |
1996
Handbook |
2002
Handbook |
2006
Handbook |
2007
Handbook |
| Please indicate the Year of the
Newest Norm Tables you have: |
| 1984
Norm Tables |
1992 Norm Tables |
1996
Norm Tables |
2002
Norm Tables |
2007
Norm Tables |
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| The sale and use of
the T-JTA is restricted in accordance with standards established by
the professional counseling associations. In particular, a test user
should have a general knowledge of measurement priciples and of the
limitations of test interpretation. Therefore, the T-JTA is made
available only to tose individuals who have obtained a relevant
degree from or who are currently enrolled (Provisional Approval) in
a college or seminary. |
| Are your training classes of
seminars likely to include individuals who are not graduates of or
enrolled in a college or seminary? |
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Yes |
No |
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| INSTRUCTOR
AGREEMENT |
I agree to accept
for T-JTA training only those persons who meet the requirements for
eligibility to purchase
and use the T-JTA as explained above and
in the Instructor's Guidelines. I agree to have each
trainee
complete an Application to Purchase \Qualification
Summary, and immediately upon the completion of training, I will
collect, co-sign, and return these forms to Psychological
Publications, Inc. for approval. |
| I agree with the above
statement |
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