ASCOT Form 1 (Single Version Questions)

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
Send a copy of the form to this email address
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?
ASCOT SCT4 (four-level self-completion tool that measures the current SCRQoL in community setting)

Select
ASCOT INT4 (four-level interview tool that measures current and expected SCRQoL in community settings)

Select
ASCOT Carer SCT4 (four-level self-report version for family/friend (unpaid) carers that measures current carer SCRQoL in community settings)

Select
ASCOT Carer INT4 (A four-level interview version for family/friend (unpaid) carers that measures current and expected carer SCRQoL in community settings)

Select
ASCOT SCT4 Easy-Read (Please note that the ASCOT ER was only tested on those with learning disabilities/autism and as such cannot be used for older adults with dementia)

Select
ASCOT SCT4 Proxy (four-level self-completion proxy questionnaire, for completion by, typically, family/friend carers on behalf of the service user that measures current SCRQoL in community settings and is suitable for use in surveys).

Select
I can confirm that I will be using the ASCOT ER tool only on those with learning disabilities/autism, and not with older adults with dementia *

Confirm
I can confirm that I am not going to translate this ASCOT tool into another language *

Confirm
PROPOSED USE OF ASCOT
How do you plan to use ASCOT *

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