CSI Certification Registration Form

Certification Registration Form

Discovery Learning Inc. has certification or qualification guidelines for using Change Style Indicator®. 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 *
Facilitation Skills *
Change Style Indicator
I have previously taken the Change Style Indicator *
Intended Use of Change Style Indicator®: *
Date of Intended Use *
Date Used, Organization Type, Program Description *
Additional Information
I would like to be listed as a certified Trainer on www.discoverylearning.com
I would like to receive my facilitation materials *
Application of Change Style Indicator requires:
1. Familiarity with psychometric assessments
2. Skill in group feedback presentation
3. The capacity to understand how your preferences impact your perceptions of others
Type the characters you see in the picture to the right

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