Registration

Note: Required Fields appear in Red

First Name:

Last Name:

Company Name:

Address Information:

Street 1:

Street 2:

City:

State/Province (if applicable):

Country:

Postal Code:

Contact Information:

Telephone:

FAX:

E-Mail:

Confirm your e-mail:

Education and Certification:

Certification being requested
Certification Training ($499)    Zone B ($99)

Do you have an account already established at Pearson to administer the Golden Personality Type Profiler?
Yes   No

Do you have a Masters Degree or PhD/EdD in Psychology, Sociology, Human Services, or Nursing?
Yes   No

Educational Background

Highest degree attained:

Name of Institution where highest degree attained:

Major, or program of study:

Year degree was completed:

Have you attended any of these certification training programs?

If you answered 'Other' above, specify who you were certified by; otherwise leave blank:

If you have a certification, please tell us when you received your certification:
(date)

Do you hold a certification by, or full active membership in, any of these professional organizations?

List the title, date, and organization of any applicable training and/or courses you have completed in the use of psychological tests.

Professional experience using Psychological Tests

List professional licenses/certificates you presently hold; please provide license description, license number, issuer, where valid, and expiration date. Or identify your qualified sponsoring mentor's or organization's name, address, phone number and e-mail address.

Login and Password:

Note: If you presently hold a GoldenLLC administration account, please
check this box and enter your Golden LLC Login and Password below.

Desired Login ID
(6 to 8 characters)

Desired Password
(use letters and numbers)

>>> I have read, understand, and agree to the Terms and Conditions