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Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
E-mail

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What is your professional specialization (required)?

Licensed or Registered Psychologist
Licensed or Certified Educatiional Psychologist
Licensed or Certified Psychoanalyst
Research or Academic Psychologist
Special Education Psychometrician (i.e. for blind)
Clinical Neurologist
Clinical Psychiatrist
Industrial/ Organizational Psychologist
Counseling Psychologist
Psychology Graduate Student (APA Approved
Program)
Other professional

Where are you licensed or registered (if applicable)?

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What are your professional membership organizations (optional)?

American Psychological Association (APA)
American Psychological Society (APS)
National Register of Health Care Providers (Psych)
American Board of Professional Psychology
National Association of School Psychologists
International Neurological Society
National Academy of Neuropsychology
Society for Research in Child Development

Graduate students in psychology: Provide contact information of a sponsoring psychologist/professor.

If you answered "other" professional specialization, please describe:

Offer number (optional):

Psychologists and professionals who do not qualify through membership or license described above, may contact Psychodiagnostics for review of eligibility. Eligibility for purchase of the Music Apperception Test and its materials (except the MAT Supplement) is determined by regional requirements for licensure or registration as a qualified professional. For further inquiry, professionals may call Psychodiagnostics at 702-799-9172 or email psyinfo@psychodiangostics.com.

Agreement

I certify that I and/or persons who may use the MAT materials ordered by me have a general knowledge of measurement principles and of the limitations of test interpretations as called for in the Standards for Educational and Psychological Tests, and that I/we are qualified to use and interpret the results of the MAT as recommended by these Standards. I/we agree to comply with the basic principles of test security: Test takers must not receive answers before beginning the test; Users must adhere to copyright law and not copy, translate, alter, distribute, publish or otherwise reproduce the MAT CD, manual, supplement, or record forms in whole or in part. Access to the MAT must be limited to qualified persons who agree to safeguard their use. MAT test materials may not be resold or distributed under any circumstances. 

Clicking the Agree button indicates acceptance of and compliance with the principles above.

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