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Application to Become a  T-JTA® Authorized Instructor
Please submit the following Application to become a T-JTA® Authorized Instructor. Fill in each field and provide as much information as possible. Upon submission, you will be contacted by PPI once the information has been reviewed.

Required fields are in BLUE.
 
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Title:
First Name:
Last Name:
Account Number:
Address #1:
Address #2:
Suite:
City:
State:
Province:
Zip Code:
Country: Telephone:
Email Address:

My T-JTA training will be offered in conjunction with a:
Organization Type
Association                                        Name
Licensed Health Facility
University or College
Other Education Organization
Private Corporation
Government Organization
Non-profit Corporation
Individual
Partnership
Seminary                              Denomination
Church                                  Denomination
Other (Please specify)
Name and Address of Organization specified above
Name
Address
Address
If part of an educational course
Name of Course
Date of Course

Participants - My T-JTA trainees will fall into the following categories:
Psychologists
Marriage & Family Counselors
Social Workers
Ministers
Ministerial Students (Specify-Field of Study)  
Graduate Student (Specify-Field of Study)
Undergraduate Students (Specify-Field of Study)
Continuing Education
Chaplains
Educators
Human Resources
Other, Please specify  
When are you planning to conduct your first T-JTA training seminar or course? :
Approximate Number of Participants:
How many times a year do you plan to offer T-JTA Training?

Instructor Qualifications (check all that apply)
License, registration or certificate in a counseling-related field
License Number
Masters or higher degree in counseling-related field. Specify Degree:  
Training, certification, or teaching experience in counseling-related field. Please specify
At least 2 years’ experience using the T-JTA
Bachelor’s degree in counseling-related field. Specify Degree:
Other (Please specify)

Have you or someone else at your organization/agency ever applied or been approved to provide T-JTA Authorized Instruction?
Yes No
If yes, PPI Account Number
Date of Approval
Name of Approved Instructor
If denied, date of Denial/Reason

Describe your intended T-JTA training course subject matter(s).
1. Describe what topics will be covered in your training class or seminar:
2. Provide a course outline and explanation of your training process:

Please describe your experience with the T-JTA:
Number of years used: Approximate number of administrations:

Please check the edition year of the T-JTA Test Manual you are using:
Before 1984 1984
1992 1996
2002 2007
2010 2012
2018

Do you have a T-JTA Handbook?
Yes No
If yes, please select the edition year:
Before 1984 1984
1992 1996
2002 2007
2010 2012
2018

Please indicate the year of Norms you currently use:
Before 1984 1984
1992 2002
2007 2012
I use T-JTA Online Scoring (Norms included)

Please indicate the ways you have scored the T-JTA (check all that apply):
Handscoring Online Scoring
Computer Software Mail-in/Fax-in
Please indicate which T-JTA Reports you have used with T-JTA Online Scoring/Software(check all that apply):
Profiles Brief Reports
Interpretive Reports Report Booklets
Report Sheets Trait Suggestion Sheets

How will orders for T-JTA materials be paid?
Prepaid (Indicate method of payment)
Check
Credit Card
Official Purchase Order (U.S. only)
Wire transfer
On Consignment (U.S. only)
   

INSTRUCTOR AGREEMENT
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 principles and of the limitations of test interpretation. The T-JTA will be made available only to those individuals who have obtained a relevant degree from or who are currently enrolled in a college or seminary.
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 T-JTA Authorized Instructor Guidelines. I agree to have each trainee complete an Application/Qualification Summary, immediately following the completion of training. I will submit a list of trainees with name, address, and email address if Applications are completed online. Alternately, I will collect, co-sign, and return the Application Forms to Psychological Publications, Inc. for approval. I will complete and return to PPI a Training Registry at the time of course completion.
I agree with the above statement


 

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