Research/perceptual Agreement/request: NYC Psychological Services, PLLC

Request Perceptual Agreement Questionnaires

Dyadic and Individual measures (PAQ-D & PAQ-I) are available free of charge for research purposes. To request one or both measures, complete the form.

Researcher Agreement Form

Part 1: User name and contact information

Name, title, and highest degree:

Mailing address:

Telephone number:

Email:

Department/university/organization:

Part 2: Planned use of the PAQ

I am requesting Perceptual Agreement Questionnaire:

Dyadic Perspective

Individual Perspective

Sample: Maximum number of participants to be tested with the PAQ:

Title or subject of your intended study:

Part 3: If you are currently a student

Supervisor's name and academic title:

Supervisor's mailing address:

Supervisor's telephone number:

Supervisor's email:

Part 4: Affirmation and signature

a. I affirm that the Perceptual Agreement Questionnaire(s) (PAQ) will be used in keeping with ethical and professional standards for use of tests, as articulated in the Standards for Educational and Psychological Testing, most recent edition.

b. I agree to abide by the copyright of the PAQ. I will not reproduce PAQ question booklets or answer sheets beyond the authorized copying required to test the number of respondents specified above. I agree that I am expressly prohibited from the following, unless additional written approval is granted by the author of the PAQ: reproduction of items in research reports (including dissertations); and distribution of PAQ test materials, including booklets and scoring materials, by any means to other parties. I also agree not to use the PAQ materials for any for- profit purpose.

c. I agree to safeguard the PAQ from unsuitable or inappropriate use. To safeguard the security of the PAQ, I agree to store PAQ test materials, including test booklets and scoring materials, in secure (that is, locked) storage facilities accessible only to authorized personnel.

If this space is initialed by the researcher, I agree to donate a copy of raw research materials, with identifying information removed, as well as ASCII computer files (and documentation) and SPSS system files (or equivalent) on my research measures, to the PAQ archive directed by the authors of the PAQ.

BY SIGNING BELOW, I certify that I have read and agree with these statements. Please type in your first and last name; Your name will be used as your digital signature.

Date:

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Until you make the unconscious conscious, it will direct your life and you will call it fate.

- Carl Jung, The Red Book (2009)

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