Qualification        

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Create your profile (*required):  Simply complete the remaining sections to order MAT items and kits. Your personal information will remain private and secure. Alternatively to qualify in the United States and Canada, you may call 866-530-7742 from 9 to 5 PST Monday through Friday. Outside the United States or Canada, you may call 702-799-9172 during business hours. Relevant profile information to qualify also may be sent to sales@psychodiagnostics.com.

Title:  Ms. Miss Mrs. Mr. Dr. Prof.  

*First Name:

Middle Initial:

*Last Name:

*Country/Region: 

*Address:

*City:

*State/Providence:

*Postal Code:

*Telephone Number:

Fax:

Language:

E-mail:

Re-enter email: 

MAT Customer Number (If assigned):

I wish to subscribe to e-mails from Psychodiagnostics: subscribe

Tax Exempt ID:
(Tax exempt certificate must be on file or submitted with invoice to honor tax exempt status.)

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Required Information for Qualification to Purchase MAT Kits and Items¹

Organization:

*Position/Title:

*Responsible Party:

* Area of Specialty Psychology:

*Daytime Telephone:

Evening Telephone:

*Membership:  American Board of Professional Psychology (ABPP) American Psychological Association (APA) American Psychological Society (APS) International Neuropsychological Society (ANS), National Academy of Neuropsychology (NAN) National Association of School Psychologists (NASP) National Register of Health Care Providers in Psychology

Membership Number:

Status: Current Member or Fellow Past Member or Fellow

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License Information:

*License/Certification: Licensed/Chartered Psychologist Licensed/Nationally Certified School Psychologist Provisionally Licensed Psychologist Special Purpose Registration for Psychologist

State/Providence: 

License Number: 

Year of Expiration (YYYY): 

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Educational Background

*Degree:

*Major Field: 

*Institution: 

Relevant Training Information (optional):

Course:

Sponsoring Institution: 

Training Year (YYYY):

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¹Psychologists 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.

Agree           Don't Agree

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