*Name:
| | |
*Title:
| | |
*Organization:
| | |
*Address:
| | |
*City:
| | |
| | *Zip:
| |
*Phone:
| | Fax:
| |
*Email:
| | |
*Country:
| | |
1. To effectively determine if you meet the qualifications for a complimentary profile please answer the following:
|
*My organization's primary business activity:
| |
| |
*My department within the organization:
| |
| |
*Number of employees in your organization:
| |
| |
*I am most interested in:
| |
| |
*I am a ___________ in the evaluation of new assessment instruments:
|
| |
2. Are you certified in another assessment tool?
|
| YesNo | | |
3. Previous Birkman® |
| Have you completed, or do you think you may have completed a Birkman® Questionnaire previously? If yes, please provide your Birkman® ID# if you know it: |
| | |
If you do not know the Birkman® ID#, please provide the name under which you completed the profile (if different from above) so we may research the database.
|
| | |
| | |
