Quals-Trainee

Qualification Form for Supervised Trainees

In accordance with the APA Ethical Principles and Standards for Educational and Psychological Testing, purchase of a license 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). However, most test publishers accept orders from a graduate or postgraduate trainee with the prior endorsement of a qualified clinician who has agreed to supervise the trainee in the use of the test.

Before submitting this form you must obtain the explicit permission of a qualified clinician who will agree to supervise your use of this test. The name and email address of your supervisor must be included in this form. I reserve the right to contact that supervisor in order to confirm that your purchase request has been endorsed. Please Cancel until you have spoken with your supervisor.

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*

Email*

Which best describes your current training status?
(choose one from the dropdown menu below)* Grad student in neuropsyc assessment course Grad student in supervised internship/residency Grad student in supervised research Supervised Post-Doc (pre-licensure) None of the above

University and Department/Program in which you are enrolled*

Your University and Training Site*

University and Program in which you are enrolled*

Graduate Degree and Supervising Agency/Clinician*

It appears that you do not qualify to purchase a test license. Please contact me via email if you believe that you have a valid exception.

Trainees must obtain explicit permission from a qualified clinician who agrees to supervise the use of this test. I reserve the right to contact this clinician in order to confirm that your purchase request has been endorsed.

Supervisor’s Name and Email Address*

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

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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