Quals-Clinician - newcat.newpsyc.com

Qualification Form for Licensed Clinicians

In accordance with the APA Ethical Principles and Standards for Educational and Psychological Testing, purchase of a registration key that unlocks NewCat is restricted to clinicians qualified by training and experience to administer and interpret the Category Test who agree to the terms of the End User License Agreement (EULA). All fields marked with an asterisk (*) are required in order to submit this form. This information will be held in strict confidence for the sole purpose of maintaining an accurate record of purchase requests and will never be shared with any third party.

Full Name (excluding professional credentials)*

Email*

Professional Credentials*

Field of Study*

State or Jurisdiction of Licensure*

Reason(s) for Purchasing the Test*
(Hold down option (Win) or command key (Mac) to choose more than one option)

Opt-In to Permit Email Notification of Updates?
Agree Decline

I affirm (1) that all of the information provided above is accurate, (2) that the test will be employed as set forth in the Standards for Educational and Psychological Tests, (3) that I have read and agree to the terms of the EULA, and (4) that I assume all responsibility for the proper handling and use of the test.
If you agree to these terms, please type your full name in the Signature field below, then click the Submit button to proceed to the Fulfillment page.
Otherwise, click the Cancel link below to return to the home page without submitting the form.

Type your full name to serve as a digital signature*

Today’s Date*

Cancel Without Submitting Form