ASCOT Form 2

LICENCEE INFORMATION
Name of project/study an ASCOT license is being applied for (Please note the ASCOT licence is for use in this project only) *
Name of the person who will be the ASCOT licensee for this project *
Job title *
Email *
example@example.com
Organisation name *
Address *
Country *
Postcode *
TYPE OF ORGANISATION
Organisation Type *

Academic Central government Local government Service provider NHS Other, please specify
Version of ASCOT

Which version(s) of ascot do you want to use?
Which version(s) of ASCOT do you want to use? *

ASCOT CH4 (Please note that training is required for use of the CH4 instrument. The licence will only be granted upon completion of the training.) ASCOT in care planning (Please note that training is required for this. The licence will only be granted upon completion of the training) To use of the ‘control over daily life’ domain as part of the ICHOM Older Person Standard Set Request to translate an ASCOT Tool into a new language Translations not available from in-country ASCOT teams Requests to amend or adapt any ASCOT tool
Follow the link to access the ICHOM Older Person Standard Set
Check for existing translation languages via this link
Please specify which translated ASCOT tool you would like a licence for *
Specify which version of ASCOT you plan to translate *
Which language? *
Please note that to obtain a licence to use the German ASCOT you must complete the German ASCOT licence form available in German and English. Any questions please contact ascot-deutsch@wu.ac.at
ASCOT team will advise on existing translations or if a new one is needed
Specify which version of ASCOT you plan to amend *
Please describe how you wish to amend the software *

0/500
PROPOSED USE OF ASCOT
The type of planned use of ASCOT (please select all that apply) *

Research Evaluation Care planning Assessment and review Quality monitoring Internal auditing Student project Other, please specify
Briefly describe how you plan to use ASCOT. Please include purpose/aims, method and what impact or public benefit is expected from its use (if any). *

0/500
In which country/countries will the study/project take place? *
Start Date *

Day Month Year
End Date (maximum 5 years) *

Day Month Year
Number
The length of the project can only be 5 years maximum.
REFERENCING
ASCOT must be referenced appropriately in any publications from any studies/projects in which ASCOT is used. Guidance on how to reference ASCOT can be found here
Referencing confirmation *

I confirm that I will reference ASCOT in any publications from this study/project.
LICENCING
Download the Terms and Conditions here
Licencing confirmation *

I confirm that I have the authority to consent to the above terms and conditions on behalf of my organization and my project team.
Terms and Conditions *

I confirm that I have read and agree to the above terms and conditions on behalf of my organisation and I will ensure that all people involved in the project are aware of the terms and conditions.
A copy of your form will be emailed to you as long as you have provided a valid email address
Should be Empty:

LICENCEE INFORMATION

TYPE OF ORGANISATION

Version of ASCOT

PROPOSED USE OF ASCOT

REFERENCING

LICENCING