UAP Registration Form

Become a University Alliance Program member by completing the following application. Keep in mind, Pearson is only able to review and process complete applications. The UAP applies only to accredited degree-granting academic training institutions and campus -based counseling/assessment training centers in North America serving university students. University hospital centers, practicum, and internship settings are not eligible for the UAP. Click to view the UAP Terms and Conditions.

Once approved as a UAP member, test kits, additional protocol/record forms, Q Local software reports, and other items published by Pearson Clinical Assessment, and for which you qualify, may be purchased at a special 40% discounted rate.

When purchasing, please be prepared to use a university PO or credit card. Purchase orders can be faxed to 1-800-632-9011, or you may call 1-800-627-7271 to place an order. Be sure to include the name of the professor or training director who is the approved University Alliance member, and note the appropriate effort or promo code with your order. When you calculate your total, please include the appropriate 40% discount on your items (subject to UAP Terms and Conditions.)

If you are registering for the UAP, and will be requesting that students enrolled in a specific class purchase test manuals for classroom use, then please make sure that the course number and a list of registered students accompanies your application (or is faxed to the attention of the University Alliance Qualifications team at 800-232-1223). Inform students that they will need to reference the instructor name, course number and title, and promotional code when ordering.

This application must be completed by the professor or training director who is making the commitment. Please note that application will be required on an annual basis.

Required fields marked with an asterisk
Are you the Training Director of a university-based clinic?
Yes
No
If you are a university-based training clinic, are you a member of one of the university professional training clinic organizations (i.e., Association of Directors of Psychology Training Clinics or Association for University and College Counseling Center Directors, etc.), please specify the organization below, and include your membership number. UAP applications for university-based clinics must include a valid ADPTC (Association of Directors of Psychology Training Clinics) membership number.
Please provide your ADPTC membership number
Please describe your payment structure and clientele:
Our center serves university students
50% of the time
75% of the time
90% of the time
The maximum amount that a student may pay for assessment services is
$10 or less
$11 to $25
$26 to $50
>$50
For assessment services, most students pay
$10 or less
$11 to $25
>$50
Our center serves the community
25% of the time
50% of the time
75% of the time
>90% of the time
The maximum charged to a community member for assessment services is
$10 or less
$11 to $25
$26 t0 $50
>$50
For assessment-related services, most community-based clients pay
$10 or less
$11 to $25
$26 t0 $50
> $50
Is your clinic considered by the University/program to be
For profit
Not for profit
*Is this your first time requesting material?
Yes
No
*Name
*Title
Dept.
*Institution
*Shipping Address1
Shipping Address2
*City
*State
*Zip Code
The UAP is offered to universities and colleges in North America only.
*Office Phone
Office Fax
*Email
Best Time of Day to Contact
Course Information
Please provide information for the courses you are teaching
*Course Acronym 1
*Course Number 1
*Course Name 1
Course Acronym 2
Course Number 2
Course Name 2
Course Acronym 3
Course Number 3
Course Name 3
Pearson is committed to maintaining professional standards in testing as presented in the Standards for Educational and Psychological Testing published by the AERA, APA, and NCME. Please establish your qualification level to ensure that you meet the criteria necessary to purchase these tests. To view the Pearson qualification policy and levels, click here.
*Qualification Level you are requesting:
Valid license or certificate issued by a state regulatory board (for example, LP, LPC, LCSW or other):
Certificate/License Number
License Type
Certifying or Licensing Agency
State
Expiration Date
OR
Highest professional degree attained:
Year
Institution
Degree
Major Field
Additional Training Courses:
Yes, completed coursework
No, didn't complete coursework
If yes Course
Date
If yes Institution
Graduate level
Undergraduate level
Participation in related Pearson-approved workshop:
Workshop Name
Date
Location
Leader
    I Agree that:
  • I am qualified to properly use any Pearson products I order, and I have provided Pearson with only accurate and true qualification information.
  • Any Pearson test products purchased under my account will be used by me and/or under my supervision.
  • Any Pearson test products purchased under my account will be used in accordance with all applicable legal and ethical guidelines.
  • I have provided accurate information on this application with respect to program information and clinic fee policies.
  • I have read and hereby apply Pearson terms and conditions to all orders for my account and will abide by the Pearson UAP Terms and Conditions and Qualification Criteria web pages. Please check this box in order for your application to be processed.