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Membership Helps our staff understand your affiliations. Not shown in the public directory.
Licenses and Certifications Please upload copies in the Supporting Documents section below.
Courses Check each course, workshop or training's level at which it was completed, and the date completed.
Courses Assessment Course - Achievement
Level of study for Assessment Course - Achievement Date completed for Assessment Course - Achievement Assessment Course - Intelligence Testing
Level of study for Assessment Course - Intelligence Testing Date completed for Assessment Course - Intelligence Testing Basic/Introduction Tests and Measurements
Level of study for Basic/Introduction Tests and Measurements Date completed for Basic/Introduction Tests and Measurements Career Assessment
Level of study for Career Assessment Date completed for Career Assessment Child Development
Level of study for Child Development Date completed for Child Development Learning Disabilities - Characteristics
Level of study for Learning Disabilities - Characteristics Date completed for Learning Disabilities - Characteristics Learning Disabilities - Methods
Level of study for Learning Disabilities - Methods Date completed for Learning Disabilities - Methods Neuropsychological Assessment
Level of study for Neuropsychological Assessment Date completed for Neuropsychological Assessment Reading
Level of study for Reading Date completed for Reading Statistics
Level of study for Statistics Date completed for Statistics Use of Tests in Counseling
Level of study for Use of Tests in Counseling Date completed for Use of Tests in Counseling Other courses Please list, including level of study and date completed.
Structured Literacy Training Approaches for which you've completed Level 1 / foundational training.
Your Professional Practice For each area below, please describe your knowledge and skill, including years of experience.
Psychoeducational testing experience
Independent educational evaluator experience
Teaching experience
Special area of competence Describe your "signature" as an evaluator, which best illustrates your skill in test administration and interpretation.
References List three people who can account for your diagnostic skills.
Disclaimer and Signature PRINCIPALS OF EFFECTIVE TEST USE:
• Maintain Confidentiality
• Sound, professional use of educational and psychological tests means that all test users must:
1. Maintain the security of testing materials before and after testing.
2. Avoid labeling individuals based on a single test score.
3. Adhere strictly to the copyright law and under no circumstance photocopy of otherwise reproduce answer forms, test books, or manuals.
4. Administer and score test exactly as specified in the manual.
5. Release results only to authorized persons in a form in keeping with accepted principles of test interpretation.
By my signature below, I certify and attest that all my statements and representations I have made in this form are true and I have all credentials, education, degrees, licenses and/or certifications that are legally or customarily required in my field to perform the services I have checked off on this form. Further, I certify and attest that the credentials, education, degrees, licenses and/or certifications are current and have been issued by an institution or body accredited or empowered to do so.
Additionally, I certify and attest that I have not been convicted of any felony or crimes involving professional malfeasance or abuse of any kind. I also acknowledge that a disclaimer will accompany any information disseminated by Everyone Reading Illinois, which indicates that all service providers listed in the database have signed this verification statement.
I understand that listing in the Everyone Reading Illinois database requires membership in The International Dyslexia Association and is at the complete and sole discretion of Everyone Reading Illinois. By submitting this application, I agree to accept Everyone Reading Illinois' determination regarding this request to be listed.
If this application leads to approval, I understand that false or misleading information in my application may result in my name removal from the referral list.
I also understand that my signature provides permission for a member of the committee to call my listed references and also it is an indication that the committee may ask the applicant to provide written letters for reference.
Respond time from Everyone Reading Illinois in regards to decision, is usually within one month from the receipt of the completed application in the Everyone Reading Illinois office.
