Qualification Form - ACER Shop Online

Contact Details

* denotes required field

* Title

* First name

* Surname

Position

Company / Organisation

* Street Address

* Suburb / Town

* State / Province

* Postal Code

* Country

* Contact Phone Number
Include country and area codes.

Fax Number
Include country and area codes.

* Email Address

* Confirm Email Address

Please tick if you do not wish to receive our e-newsletter
or any marketing materials from ACER.

I would like to apply for registration with ACER at the following level:

Click on the name or help icon for a description

P - Psychologist

Note: P subsumes all categories except GMDS

R - Restricted

S - Specialist

M - Moderate

T - Type accredited

GMDS

I am a:

Registered psychologist

* Registration no.

* State

Probationary psychologist under the supervision of a registered psychologist

* Registration no.

* State

Provide evidence of supervision.

* Supervisor's name

* Supervisor's qualification

* Supervisor's contact details
Address, phone numbers etc.

Australian Psychological Society member

* Membership no.

Full member

Associate member

Educational Background

Please indicate highest qualification.

* Degree or diploma

* Major area of study

* Institution

* Year Conferred

Please indicate second highest qualification (if applicable).

Degree or diploma

Major area of study

Institution

Year Conferred

Accredited training courses completed in use of tests

Please indicate T (Type accredited) or GMDS courses where appropriate.

Please fax / post copies of course certificates to ACER Press (see contact details at bottom of page).

* Test / Course

* Institution

* Date

Test / Course

Institution

Date

Previous experience in the use of tests and tests used

Major areas in which the tests are to be used

Rights and responsibilities

I have read and agree to comply with the rights and responsibilities