ASSESSOR ASSESSMENT FORM

NOTE   This form requests information about cumulative academic time spent studying psychology or aspects of psychology [empirical research project; internship].  "Cumulative full-time years in psychology"  is determined by dividing the total number of credits awarded for the accredited psychology units in the program by the total number of credits awarded in a typical year.  A four year 120 credit program would result in a typical annual credit tally of 30 credits.  If the first year of psychology credits totaled 7.5, the second years credits totaled 10, the third totaled 15 and the final year was awarded 30 points, then the full course of study in psychology would result in a sum of 62.5 credits.  62.5/30 = 2.08 years of cumulative study in psychology for that program.  A full-time 3-year program in psychology would typically result in a cumulative score of 3.0 years, but a program containing extra (prescribed) material might amount to 4.0 years.  This would be the case for "accelerated" programs.  This figure is a rough estimate of the breadth (but not the depth) of discipline-specific material covered in a program.  

Calculating the "cumulative dissertation time" is a rough measure of the complexity expected of the project.  Dissertations which are allotted credits equivalent to 0.2 of an academic year are obviously not expected to be as complex as dissertations which are assigned credits equivalent to 0.5 years;  dissertations which are allocated credits equivalent to 1-1.5 years are expected to be a lot more complex.  A dissertation which is assigned credits equivalent to 2.5-3.0 years is expected to be a very substantial piece of work.  

 

Assessed Person Data:   The information in this section will remain confidential except where it is required to clarify or authenticate the data you supply in the rest of this form.  Please contact FITPSY  if you have concerns about this. 

Name

         
Example:  Mary  Fernandez

Current Age

xx

     Example:  35
Country of Nationality     Example:  Portugal
Contact details  (see proviso above)   Email: Phone:

 

Qualifications:  Include all external supervised experience/internships, including mandatory post-graduation experience.

Qualification 1

Country of training

     
Example: United Kingdom

General name of program

  
Example: Honours Degree (Bachelor of Science)

Identifying features

xx
Example:  Joint Honours in Psychology and Computer Science.

Is this program accredited by the country's professional psychology association?  

     Yes     No   Don't Know  
Example:  No
 Notes: 
Example:  Does not meet BPS requirements for breadth and content in psychology.

Total years to complete

   yrs    Example:  3

Cumulative full-time years of psychology

     yrs   Example: 1.4 yrs

Full-time years allocated to Thesis/Dissertation in psychology [credits divided by typical annual credits]

   yrs    Example:  0
 Notes: 
Example:  Completed project in Computer Science (0.2yrs)
Performance grading      Example:  H2A

 

Qualification 2

Country of training

  

  
Example: Australia

General name of program

  
Example:  Bachelor of Arts (Honours)

Identifying features

  
Example:  Honours Year in psychology
Is this program accredited by the country's professional psychology association?       Yes     No   Don't Know  
Example:  Yes
Notes: 
Example:  Confers provisional registration.

Total years to complete

   yrs    Example: 1 yrs

Cumulative full-time years of psychology

xx

  yrs   Example: 1 yrs

Full-time years allocated to Thesis/Dissertation in psychology [credits divided by typical annual credits

   yrs    Example:  0.5 yrs
  Notes:
Example:  Thesis  titled:  "Computer-assisted problem solving in patients with Hunter's paradoxical syndrome".  Published in the J.Esoteric Psych., June 1984.
Performance grading      Example:  H. Distinction

 

Qualification 3

Country of training

     
Example: Australia

General name of program

  
Example: Master of Science (Clin.Psych.)

Identifying features

  
Example:  Prof. Masters program in Clinical Psych.

Is this program accredited by the country's professional psychology association?  

     Yes     No   Don't Know  Example:  Yes
Notes:
Example:  After an appropriate post-graduation internship, this program provides eligibility for membership of the APsS College of Clinical Psychologists. 

Total years to complete

xx

yrs    Example:  2

Cumulative full-time years of psychology

     yrs   Example: 2.0 yrs

Full-time years allocated to Thesis/Dissertation in psychology [credits divided by typical annual credits]

   yrs    Example:  0.4 yrs
Notes: 
Example:  Title:  "A Factor Analytic Model of the brain-waves of Type P bi-polar disorder during thumb twiddling behaviour."   Unpublished.
Performance grading      Example:  Honours

 

Qualification 4

Country of training

     
Example: New Zealand

General name of program

  
Example: Post-graduation supervised experience

Identifying features

xx
Example:  Supervised employment with the Mental Health Department in the North Island.

Is this program accredited by the country's professional psychology association?  

     Yes     No   Don't Know  Example:  Yes
Notes:
Example: Eligibility requirement for membership of the APsS College of Clinical Psychology. 

Total years to complete

   yrs    Example:  2 yrs

Cumulative full-time years of psychology

     yrs   Example: 2 yrs

Full-time years allocated to Thesis/Dissertation in psychology [credits divided by typical annual credits]

   yrs    Example:  0
Notes:
Casebook submitted with 30 entries. 
Performance grading      Example: Pass

 

Qualification 5

Country of training

     
Example: Australia

General name of program

  
Example: Post-Graduate Diploma

Identifying features

  
Example:  Counseling
Is this program accredited by the country's professional psychology association?  

xx

   Yes     No   Don't Know  
Example:  No
Notes: 
Example:  An accredited terminal fourth year. (Lower than Honours)

Total years to complete

   yrs    Example:  1yr

Cumulative full-time years of psychology

     yrs   Example: 1 yr

Full-time years allocated to Thesis/Dissertation in psychology [credits divided by typical annual credits]

   yrs    Example:  0
Notes:
Example:  Research project:  "A study of process intervention indicators throughout a six-week counseling session with a client complaining of incurable sanity."
Performance grading      Example:  H2A

 

Qualification 6

Country of training

     
Example: Australia

General name of program

  
Example:  Supervised work experience 

Identifying features

xx
Example:  Counseling 

Is this program accredited by the country's professional psychology association?  

     Yes     No   Don't Know  Example:  Yes
Notes:
Example:  Eligibility requirement for membership of the APsS College of Counseling Psychologists

Total years to complete

   yrs    Example:  2

Cumulative full-time years of psychology

     yrs   Example: 2 yrs

Full-time years allocated to Thesis/Dissertation in psychology [credits divided by typical annual credits]

   yrs    Example:  0
Notes:
Completed case book of 20 cases
Performance grading      Example:  Satisfactory

 

Qualification 7

Country of training

     
  

General name of program

  
  

Identifying features

  
 
Is this program accredited by the country's professional psychology association?       Yes     No   Don't Know  
Notes: 

Total years to complete

   yrs    

Cumulative full-time years of psychology

xx

  yrs   
Full-time years allocated to Thesis/Dissertation in psychology [credits divided by typical annual credits]   yrs   
 Notes:
Performance grading       

 

Qualification 8

Country of training

     
  

General name of program

  
  

Identifying features

xx
 
Is this program accredited by the country's professional psychology association?       Yes     No   Don't Know 
Notes: 

Total years to complete

   yrs    

Cumulative full-time years of psychology

     yrs   
Full-time years allocated to Thesis/Dissertation in psychology [credits divided by typical annual credits]   yrs   
Notes:
Performance grading       

 

Summary Data

  Sum of cumulative years of full-time training in psychology

xx
Example: 9

 Sum of cumulative years of theoretical training 

  
Example: 5.4

Sum of cumulative years of practicum training 

  
Example: 4

Cumulative number of theses/dissertations 

  
Example: 2

Sum of cumulative years of credited dissertation time

  
Example: 0.9

 

Professional Memberships/Accreditation

Professional Associations
(Include level of Membership)

xx

 Example: Australian Psychological Society; 
Member British Psychological Society; Foreign Ass.

Specialist Colleges/Boards
(include level of membership)

xx

 Example: APsS College of Clinical Psychologists (Member);  
APsS College of Counseling Psychologists (Ass.Member)

Professional Registration/Licences 
(State, Country and Type)

   Example:  Western Australia (Aust):  Registered Clinical Psychologist;
Victoria (Aust): Registered Psychologist

Other

   Example:  Supervised 4 post-graduate specialists in clinical psychology.
President of the Kallamazoo Branch of the APsS from 1992-93.

 

Assessor 1 Data

Assessing agency name

  
Example:  World Education Service

Country of assessment agency

xx

  
Example:  USA

Assessor's name (if known)

  
Example:  Val. Ewan-Loh

Is this person a licensed psychologist?

    Yes      No    Don't Know
Example:  Don't Know

Date of assessment.

     Example:  3/4/2001

 

Assessor 1 Equivalency Rating

Country of equivalence

  
Example:  USA  

 Qualification 1  - equivalence awarded

  
Example:  College Bachelor

Typical cumulative psychology years (if known)

   yrs
Example:  1.2 yrs

 Qualification 2  - equivalence awarded

  
Example:   College Bachelor - No additional credit

Typical cumulative psychology years (if known)

   yrs
Example:  0

 Qualification 3  - equivalence awarded

  
Example:  Master 

Typical cumulative psychology years (if known)

   yrs
Example:  1-2 yrs

 Qualification 4  - equivalence awarded

  
Example: Not counted

Typical cumulative psychology years (if known)

   yrs
Example: 0

 Qualification 5  - equivalence awarded

  
Example: Bachelor - no additional credit

Typical cumulative psychology years (if known)

   yrs
Example: N/A

 Qualification 6  - equivalence awarded

  
Example:  Not counted

Typical cumulative psychology years (if known)

   yrs
Example:  N/A

 Qualification 7  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 8  - equivalence awarded

  
Typical cumulative psychology years (if known)

xx

 yrs

 Summary

    
Cumulative years of full-time psychology training for all equivalencies awarded (if known)   yrs
Example:  2.2 - 3.2 yrs

Comments from assessor

  
Example:  The candidate does not show evidence of doctoral studies.

Comments from the assessed person

  
Example:  Programs labeled "doctorate" are not designed to teach professional psychology in my country of training.  If I had taken one I would have been restricted to the research field or to practising psychology in the USA. 

 

Assessor 2 Data

Assessing agency name

  
Example:  British Psychological Society

Country of assessment agency

xx

  
Example: UK

Assessor's name (if known)

  
Example:  Don't Know

Is this person a licensed psychologist?

    Yes      No    Don't Know
Example:  Yes

Date of assessment.

     Example:  3/6/2002

Assessor 2 Equivalency Rating

Country of equivalence  

 Qualification 1  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 2  - equivalence awarded

     
Typical cumulative psychology years (if known)   yrs

 Qualification 3  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 4  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 5  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 6  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 7  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 8  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Summary

    
Cumulative years of full-time psychology training for all equivalencies awarded (if known)   yrs
Comments from assessor  
Comments from the assessed person

xx

 

Assessor 3 Data

Assessing agency name

xx
Country of assessment agency    
Assessor's name (if known)  

Is this person a licensed psychologist?

    Yes      No    Don't Know

Date of assessment.

     

 

Assessor 3 Equivalency Rating

Country of equivalence  

 Qualification 1  - equivalence awarded

xx

Typical cumulative psychology years (if known)   yrs

 Qualification 2  - equivalence awarded

     
Typical cumulative psychology years (if known)   yrs

 Qualification 3  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 4  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 5  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 6  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 7  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 8  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Summary

    
Cumulative years of full-time psychology training for all equivalencies awarded (if known)   yrs
Comments from assessor

xx
Comments from the assessed person  

 

Assessor 4 Data

Assessing agency name

xx
Country of assessment agency

xx

  
Assessor's name (if known)

xx

Is this person a licensed psychologist?

xx

 Yes      No    Don't Know

Date of assessment.

xx

  

 

Assessor 4 Equivalency Rating

Country of equivalence

 

 Qualification 1  - equivalence awarded

xx

Typical cumulative psychology years (if known)

xx

 yrs

 Qualification 2  - equivalence awarded

xx

  
Typical cumulative psychology years (if known)

xx

 yrs

 Qualification 3  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 4  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 5  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 6  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 7  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Qualification 8  - equivalence awarded

  
Typical cumulative psychology years (if known)   yrs

 Summary

    

Cumulative years of full-time psychology training for all equivalencies awarded (if known)

   yrs
Comments from assessor  
Comments from the assessed person