PQR: Professional Qualification Registration Form - Outside the Box Learning Resources

Name

First Last

Address*

Address 1 Address 2 City State / Province / Region Eircode Country

Email*

Phone*

Organisation / School*

School Roll Number (If applicable)

Job Title*

Qualifications*

Please enter Qualification Title, Course and Awarding Body. Separate multiple qualifications with a comma. Enter N/A if not applicable.

College of Study*

Sphere*

Speech & Language Therapy
Occupational Therapy
Psychology
Teaching
Other Allied Health Therapy

Other Allied Health Therapy

Professional Body/Organisation*

IASLT
AOTI
Psychological Society of Ireland
Teaching Council
Other

Other Professional Body/Organisation

Select Role

Speech & Language Therapy
Occupational Therapy
Psychology
Teaching
Other Allied Health Therapy
Wholesaler

Registration number / Coru number*

Further Information

QUALIFICATION USERS (more information on www.otb.ie/qualification-levels): QUALIFICATION LEVEL A: Individuals with a DEGREE in education / QUALIFICATION LEVEL B: Individuals with a MASTERS DEGREE in psychology, education, occupational therapy, social work, counseling or in a field closely related to the intended use of the assessment and formal training in the ethical administration, scoring and interpretation of clinical assessments / QUALIFICATION LEVEL C: Individuals with a DOCTORATE DEGREE in psychology, education or closely related field with formal training in the ethical administration, scoring and interpretation of clinical assessments related to the intended use of the assessment.

Declaration

I hereby declare that the information given by me in this form is true, accurate and correct.

Consent

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