Field Examiner Portal

Field Examiner Registration

First Name*

Last Name*

E-Mail Address*

Password*

Confirm Password*

Position or Title

Agency or Affiliation

Mailing Address (no PO Box)*

Address Line 2

City*

State*

Zip Code*

Home Phone*

Work Phone*

ASHA License Number

State License Number

State Licensed In

What is the highest degree you have attained?*

Associate Doctoral Bachelor's Specialist Degree (i.e., Ed.S., SSP, or Psy.S.) Master's Other

What best describes your current employment status?*

Full time Part time Student/Undergraduate Student/Graduate School

What ages (in years) are you able to test? Check all that apply.

Early Childhood (0-3)

School Age (4-18)

College Age (18-22)

Young Adult Age (18-30)

Middle Age (31-65)

Senior Adults (65+)

The percentage of individuals you evaluate who are:

% African American/Black

% Asian/Pacific Islander

% White

% Native American/Eskimo/Aleut

% Two or More

Regardless of race, what percentage of the clients you evaluate are of Hispanic origin?

% Hispanic Origin

How did you hear about PRO-ED field testing?

PRO-ED web store Conference Social Media Mailing Email Catalog Word of mouth Other

Acknowledgement: Please enter your name as you would like it to appear on the acknowledgement page of the test manual.