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

Contact Details

Name*

First Last

Email*

Phone*

School/Organisation Name (if applicable)

Address*

Address 1 Address 2 Town/City County Eircode Country

Account Number / School Roll Number (If applicable)

Assessments: Please tick this box if you wish to order restricted assessments or record forms

Register for Restricted Assessment Ordering

PQR: Professional Qualification Registration

Profession

Teacher
Speech & Language Therapist
Occupational Therapist
Physiotherapist
Psychologist
Psychiatrist
Other

Other Profession (if not listed above)

Professional Body/Organisation Membership

IASLT
AOTI
Psychological Society of Ireland
Teaching Council
Other

Other Professional Body/Organisation (if not listed above)

Qualification(s)

Please enter Qualification Title, Course and Awarding Body. Separate multiple qualifications with a comma.

College of Study

Professional Body Registration number (e.g. 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

Consent*

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