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Breckenridge Application Form

Thank you for your interest in the Breckenridge line of personality assessments. Please complete the following information and click the "Send Request" button to send your sign-up information to the Breckenridge Institute®.

Contact Information
Email:
First Name:
Last Name:
Title:
Organization:
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Address 2:
City

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or Region

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Education
Please list the highest degree obtained
Degree Year Completed Institution Major
                   
Psychometric/Testing Courses
Please list any and all coursework in psychometric or educational tests and measures that you have completed. Indicate if the coursework was undergraduate or graduate, the institution, and completion date.

A scanned copy of the grade report must be emailed to elin@breckenridgeinstitute.com for the application to be processed.
Course (G) (U) Institution Date Attended
                   
Training Programs
Please list the Instrument, Provider, Location, and Dates Attended of any
Qualifying Programs you have completed.

A scanned copy of the grade report must be emailed to elin@breckenridgeinstitute.com for the application to be processed.
Instrument Provider Location Date Attended
       
Signature and Agreement

The VAR account user certifies that they have read Mark Bodnarczuk’s book, The Breckenridge Enneagram: A Guide to Personal and Professional Growth and have a personal knowledge of the principles, practices, and theoretical framework of the Breckenridge Enneagram™. The VAR account user certifies that they have read the BTI™ Psychometric Report published by the Breckenridge Institute® and have a personal knowledge of the psychometric properties of the BTI™ instrument.

The VAR account user also certifies that they have the appropriate training for the appropriate and ethical use of psychological tests, including a personal knowledge of professional testing standards such as the APA Standards for Educational and Psychological Testing and commits to follow those standards. The VAR account user assumes full responsibility for the proper administration, use, and interpretation of the BTI™ and certifies that in the use of this instrument and report materials will adhere to applicable local and national laws and regulations.
I have read and agree to the VAR terms of use. VAR TERMS OF USE
   
Signature: (Enter Full Name)
Date: (Enter Date)
   
* Your Name and Email fields are required.
Your application form will be reviewed and processed within 24-48 hours after receiving all information.



For more information, contact the Breckenridge Institute at info@breckenridgeinstitute.com.


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