The Psychological Resources Center (PSYCENTER) requires all first time buyers to provie evience of their professional

qualification to use psychological tests materials! Please fill in the information requeste belo"! Rea carefully the #cceptance of
Responsibility clause an sign the form to inicate acceptance in the proper use of the materials!
$entification $nformation (Please print or type)
Name %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Company Employer %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Phone %%%%%%%%%%%%%%%%%%%%%%% Email%%%%%%%%%%%%%%%%%%%%%%%%% Phone %%%%%%%%%%%%%%%%%%%%%%% &a' %%%%%%%%%%%%%%%%%%%%%%%%%
Position %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Supervisor %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
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A. Appropriate Training in the Use of Tests
(! )evel of training (Please chec*!)+
,octoral Year $nstitution &iel of Stuy
-asters ,egree Year $nstitution &iel of Stuy
.achelor/s ,egree Year $nstitution &iel of Stuy
0! #reas of E'pertise (Please chec* appropriate bo'es)
Clinical1-ental 2ealth Special Eucation 3ccupational Therapy
Psychiatry Career an 4ocational Training Rehabilitation
School Psychology Personal Speech1)anguage12earing
-arriage 5 &amily Counseling 3thers+ %%%%%%%%%%%%%%%%%%
6! Courses (Please chec* bo'es!)+
.asic Tests an -easurement #ssessment course in ma7or fiel
,escriptive Statistics 8se in Test Counseling
$ntelligence1cognitive Testing Career #ssessment
Speech9 hearing9 language assessment Eucation ,iagnostics
Pro7ective techniques Neuropsychological assessment
3thers (Please )ist!) %%%%%%%%%%%%%%%%%%%%%%%%%%%%
:! 3ther Stuy (Please chec* bo'es!)+
Practicum in test #ministration $nternship (school psychology1counseling)
#ttening "or*shop1seminars (Please specify!) %%%%%%%%%%%%%%%%%%%%%%%%%
B. Acceptance of Responsibility for the Use of Tests
Professional use of eucational an psychological tests measure that all tests users must+
-aintain the security of testing materials before an after testing!
#minister9 score9 interpret an use tests e'actly as specifie in the manual!
Release results only to authori;e persons an in form of *eeping "ith accepte principles of tests interpretation!
#here strictly to the C3PYR$<2T )#= an uner no circumstances photocopy or other"ise reprouce ans"er forms9 test boo*lets9 or manuals!
$ certify that $ have the appropriate training an competence to aminister9 score an interpret the test materials being purchase! $
assume full responsibility for the proper use of the testing materials $ orer from PSYCENTER! $ affi' my signature to inicate
acceptance of an compliance "ith the above principles!
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Signature over Printe Name ,ate
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IPsyCenter/Forms/qualification
06.17.021dff
Psychological Resources Center
Nurturing Minds Enhancing Lives
Unit 2F-A FSS Building 89 Scout Castor Street Roces Avenue Brgy Laging Handa Quezon City
!one" #$2% &'(-)99* to &'()998 e+ail",sycenter2$$2-ya!oo.co+
QUALIFICATION/ACCEPTANCE OF RESPONSIBILITY FORM
Membership ID Form
Name: [
Birthday: [
Contact No: [
Address: [
Position: [
Signature: [
Qualification Level: [ (lease leve !lan"
Note: Please attach your icture #$#
GUIDELINES FOR ACCREDITATION
(! #PP)$C#T$3N &3R-! # client "ho "ants to purchase psychological testing materials or avail of testing
services from PSYCENTER either for his1her o"n use or for use of the company1school he represents
shall have to fill>up an application form to qualify! The client is require to submit the fille>up
application form together "ith her1his resume9 an the follo"ing ocuments+
Photocopy of Transcript of Recors
0 pcs! ( ' ( $!,! pictures
Certificate of Employment
Php 0?@ for -embership $, (vali for 6 years)
0! PSYCENTER shall evaluate the clientAs qualification base on the application form an resume
submitte an shall classify the client as to levels for "hich he1she can avail of certain test materials! The
follo"ing classification levels shall apply "ith the corresponing test materials that the clients are qualifie to purchase+
# > $!B! 1 E!B! Personality $nventory
. > Personality ,isorers $nventory
.usiness 1 $nustry )ight Pro7ective Tests ( incluing # )
C > Pro7ective Tests ( incluing # 5 . )
6! $N 238SE TR#$N$N< C3NS8)T#T$3N! PSYCENTER shall upon request of clients9 provie one>on>one or small
group training1consultation to qualifie clients in areas of test aministration9 interpretation an psychological
analysis report "riting an other relate areas!
:! SE-$N#R 1 =3RCS23P! PSYCENTER shall sponsor seminar1"or*shops at least once a year on Psychology testing relate
topics! These seminar1"or*shops are open to>all clients as "ell as other intereste parties an iniviuals! Certificates of
attenance shall be given to participants "ho have complete the "or*shops! &or accreite clients9 these
seminar1"or*shops shall be creite to their qualifications on recor an may upgrae their qualification
levels! (e!g! from level # to level .)
?! &REB8ENT P8RC2#SE $NCENT$4ES! #ccreite clients "ho have impressive tract recors of purchases shall get
incentives in *in9 proportionate to the total amount of their purchase! The client has the option to
onate the incentive to the institution that they represent!
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IPsyCenter/Forms/qualification
06.17.021dff