University Alliance Program

Are you the Training Director of a university-based clinic? Yes No

UAP applications for university-based clinics must include a valid ADPTC (Association of Directors of Psychology Training Clinics) membership number.

Please provide your ADPTC membership number

*Is this your first time requesting material? YesNo

*Name
*Title
Dept.
*Institution
*Shipping Address1
Shipping Address2
*City
*State

*Zip Code
The UAP is offered to universities and colleges in the

United States

only.
*Office Phone
Office Fax
*Email

*Password Please create a password which you'll need for future UAP requests.

Best Time of Day to Contact

Course Information

Acronym Number Title/Description

Pearson is committed to maintaining professional standards in testing as presented in the Standards for Educational and Psychological Testing published by the AERA, APA, and NCME. Please establish your qualification level to ensure that you meet the criteria necessary to purchase these tests. To view the Pearson qualification policy and levels, click here.

*Qualification Level you are requesting:

Valid license or certificate issued by a state regulatory board (for example, LP, LPC, LCSW or other):

Certificate/License Number

License Type

Certifying or Licensing Agency

State Expiration Date

OR

Highest professional degree attained:

Year Institution

Degree Major Field

Coursework Completed in Tests and Measurement:

Yes, completed coursework No, didn't complete coursework

If yes Course Date

If yes Institution

Graduate level Undergraduate level

Participation in related Pearson-approved workshop:

Workshop Name

Date Location

Leader

(description of qualification levels and requirements)

I Agree that:
I am qualified to properly use any Pearson products I order, and I have provided Pearson with only accurate and true qualification information.

Any Pearson test products purchased under my account will be used by me and/or under my supervision.

Any Pearson test products purchased under my account will be used in accordance with all applicable legal and ethical guidelines.

I have read and hereby apply Pearson terms and conditions to all orders for my account and will abide by the Pearson UAP Terms and Conditions and Qualification Criteria web pages. Please check this box in order for your application to be processed.

If your UAP application is complete, we will process it within ten business days of receipt. If you would like to place an order for additional protocol/record forms, Q Local software reports, and other items at the special 40% UAP discounted rate, please allow ten business days for your application to be processed before placing your order.

To Reach the UAP Director
Call: 1-800-627-7271 ext. 6418
Fax: 1-800-632-9011 or 952-681-3299
E-Mail: pearsonassessments@pearson.com

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Registering for the University Alliance Program