ATP Assessments Study Sign-up

Please select the studies for which you would like to participate:
(Required)*

The Expressive and Receptive One-Word Picture Vocabulary Tests (EOWPVT & ROWPVT)The Abbreviated Test of Working Memory (aTWM)The Language-Neutral Assessment of Motor Speech (LAMS)The Test of Information Processing Skills, Second Edition (TIPS-2)The Receptive, Expressive, and Social Communication Assessment – Early Language Edition (RESCA-ELD)The Receptive, Expressive, Social Communication Assessment-Adolescent (RESCA-A)The Receptive, Expressive, Social Communication Assessment-Elementary, 2nd Edition (RESCA-E2)The Screening Assessment of Sensory Integration (SASI)Future Studies
Type of Request:*

I want to be considered for a future testing study
Name and Qualifications
Full Name*

First NameLast Name
Occupation*

AudiologyEducation- Early ChildhoodEducation- K-12Education- SecondaryOccupational TherapyPsychology- SchoolPsychology- ClinicalSpeech Language PathologyPhysical TherapyOther
Degree*

Bachelor of Science (BS)Bachelor of Science (BSc)Graduate CertificateEducation Specialist (EdS)Master of Arts (MA)Master of Education (MEd)Master of Occupational Therapy (MOT)Master of Science (MS)Master of Science (MSc)Doctor of Audiology (AUDD)Doctor of Psychology (PsyD)Doctor of Education (EdD)Doctor of Philosophy (PhD)Doctor of Physical Therapy (DPT)Doctor of Science (ScD)Other
Certifications & Licensure:
Certification

CCC-A (Certificate of Clinical Competence in Audiology)CCC-A/SLP (Certificate of Clinical Competence in Audiology/ Speech Language Pathology)CCC-SLP (Certificate of Clinical Competence in Speech Language Pathology)Certified Educational DiagnosticianRegistered/Licensed Occupational TherapistCertified/Licensed School PsychologistCertified Reading SpecialistCertified TeacherLicensed/Charted PsychologistLicensed Physical TherapistLicensed Psychological AssociateLicensed Psychological ExaminerProvisionally Licensed PsychologistOther
Type of Certification or License*

National CertificationState Certification or License
Select both National Certification AND State Certification/License if your state requires it.
National
Certification
Information
(Required)
National Certification Number*
National Expiration Date*

MonthDayYear
State
Certification
or Licensure
Information
(Required)
State Certification or License Number*
State Licensing Agency*
Does your State Certification or License have an Expiration Date?*

YesNo
State Expiration Date

MonthDayYear
Are you Spanish bilingual?

YesNo
Ages of Students/Patients With Whom You Generally Work:*

0-456-1011-1314-1718-1920-5960+
Email Information
Primary E-mail*
Secondary E-mail
example@example.com
Shipping Address
Is this address commercial or residential?*

CommercialResidential
Name*

First NameLast Name
Organization, School, Agency
Shipping Address*

Street Address - No PO Boxes Please

Address Line 2 - Building or Apartment Number, Department etc

CityState

Zip Code
Phone Number:*

Area CodePhone Number
Fax Number:

Area CodeFax Number
Alternate Contact Information (Optional)
Would you like to provide an alternate address and contact info?

YesNo
Mailing Address (Alternate)*

Street Address

Address Line 2 - Building or Apartment Number, Department etc

CityState

Zip Code
School District (if applicable):
Phone Number (Alternate):

Area CodePhone Number
Fax Number (Alternate):

Area CodeFax Number
How Did You Hear About the Study
Please Select*

Email from ATPPostcard from ATPProfessional ConferenceATP WebsiteReferral from ColleagueOther
Additional Comments (Optional)

If you have important information regarding your qualifications/ability to participate, please indicate here.
Additional Comments
By applying to participate in a study you are permitting ATP Assessments / High Noon Books to use your personal information for the purposes of evaluating your eligibility to participate in various studies, and conduct communications related to the study via email and printed mail. We will not use your information for marketing purposes unless you have opted in to do so elsewhere while making purchases or participating in product drawings or other trade show events. We do not sell or trade your information with other companies or organizations.
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