Change Readiness Gauge Certification Registration Form

Certification Registration Form

Discovery Learning Inc. has certification or qualification guidelines for using the Change Readiness Gauge™. Our intent is to enhance the appropriate use of this product by professionals who are trained and experienced in the application of assessment tools and feedback techniques.

Meeting the certification or qualification guidelines are a prerequisite to placing a product order. If you have questions regarding any of the requested information, please contact a Discovery Learning® representative.

I would like to be considered for qualification *
Name *
Organization *
Title *
Address 1 *
Address 2
City *
State
Zip/Postal Code *
Country *
Phone *
Fax
Email *
Education
Institution, Degree Earned and Major, Year Earned *
Relevant Certifications/Licensures
Certification/Licensure, Year Certified and Certifying Organization, Date of Last Use *
Additional Information
Intended use of Change Readiness Gauge *
Date of intended use *
I would like to be listed as a certified trainer on www.discoverylearning.com *
Application of Change Readiness Gauge Requires
1. Familiarity with psychometric assessments
2. Skill in group feedback presentations
Type the characters you see to the right

By clicking "Submit" above, I attest that the information provided above is accurate
to the best of my knowledge