Research

A Call to Test Examiners/Administrators to Participate in Future Riverside Publishing Research Studies

The Riverside Publishing Company is seeking assessment professionals to participate in upcoming test standardizations. Your participation in such studies can help us maintain the high quality standards of Riverside Publishing assessment instruments. Details of any particular study will be specified when it is sent to you for your consideration. Completion and submission of this form does not commit you to participation in future studies.

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Name * Position/Title *     Agency/Affiliation *     Address Line 1 *     Address Line 2     City *     State *     Zip Code *     Work Phone *     Other Phone     Fax Number     E-mail Address *

1. In which of the following areas might you or your staff consider participating for future test tryouts or standardizations? (Check all that apply) Adaptive/Self-Help Adult Communication Disorders Child Language Early Childhood (ages 0 – 3) Geriatrics     Motor Development Pediatric/Adult Head Injury Performance/Achievement Tests Special Education/Academic Testing of Cognitive/General Abilities

2. Which of the following are represented on your staff? (Check all that apply) Clinical/Counseling Psychologist Developmental Psychologist Early Intervention Specialist Educational Diagnostician Guidance/Career Counselor Neuropsychologist     Nurse Occupational Therapist Parent/Child Advocate Physical Therapist Physician Preschool/Early Childhood Ed.     Psychiatrist Speech Language Pathologist School Psychologist Social Worker Special Educator Other

3. Which of the following best describes your place of employment? Preschool Elementary School Middle School High School School (Other)     Private Practice Private Agency Hospital Rehabilitation Governmental     University/Training Institution Community-based Service Program Other

4. The percentage of clients you evaluate are:     At Risk         Special         Normally Developing

5. Do you have access to:     Normally developing children?     yes no     Normal adults?     yes no

6. What individuals do you have access to with the following types of special needs? (Check all that apply) ADHD Autism/Asperger’s Syndrome Bilingual Education Correctional Institution Inmates Developmentally Delayed ESL (English as a Second Language)     Gifted Orthopedic Impairments Hearing Impaired Language Immersion Learning Disabled LEP (Limited English Proficient) Mental Retardation     Serious Emotional Disturbance Specific Learning Disabled Speech/Language Impaired Traumatic Brain Injury Visually Impaired Other

7. The percentage of clients you evaluate are: African American/Black     Caucasian/White     Other   Asian         Native American/American Indian

8.  Regardless of race, what percentage of the clients you assess are of Hispanic origin?

9. Among the Hispanic clients, approximately what percentage do NOT speak English proficiently?

10. What is the approximate size of the communities you serve? (Check all that apply) 100,000+ 50,000 - 99,999     10,000 - 49,999 5,000 - 9,999     1,000 - 4,999 Less than 1,000

11. What types of communities do you serve?:     Rural     Urban     Suburban

12. What percentage of your clients are in the following income brackets?    Upper       Middle       Lower

Additional Comments or Questions