2016 Woodcock-Johnson IV Tests of Cognitive Abilities Order Form

Transcription

1 Page 1 of Woodcock-Johnson IV Tests of Cognitive Abilities Order Form Date / / Payment Information Please enclose a check, money order, or valid purchase order with all orders. Purchase Order enclosed. Number Check enclosed. Number Money Order enclosed. IMPORTANT NOTE FOR CREDIT CARD USERS: For your security, we can only accept credit card orders through our secure website, hmhco.com/hmhassessment, or by phone at Customers wishing to remit payment by credit card will be contacted by HMH Customer Experience once their order has been processed. Exempt from state sales tax. (Please attach copy of certificate) Cert. no. Cert. Expiration Date Charge to: (See note above) Position Billing Address City State Zip Phone: ( ) Fax: ( ) address Professional Credentials Choose One: Test Purchaser Qualification Form attached Licensed In (area): State License Expiration Date Member of professional organizations (Check all that apply.) ACA AERA AMA APA ASHA CEC NASP NCME Other Ship to: (if different from billing address) Position Shipping Address City State Zip Phone: ( ) Fax: ( ) address * * * RequireD INFORMATION * * * All web-based WJ-IV scoring and reporting requires an Account Holder. Your order CANnot be processed without this information! Account Holder: This person will be the primary administrative, IT and implementation contact for WJ IV web-based scoring in your organization or institution. There may be only one Account Holder. Check here if you already have an Account Holder on file. Is this your first WJ IV order? Yes No address* (*REQUIRED provides access to reporting) Phone: ( ) Note: Orders from first time purchasers require a completed Test Purchaser Qualification Form. hmhco.com

2 Page 2 of 5 Complete Plus: Achievement, Cognitive, and Oral Language WJ IV Complete Battery Plus (Achievement A, Cognitive, Oral Language) with Case $2, WJ IV Technical Manual CD, OL Examiner s Training Workbook, OL Standard Test Book, OL Test Records w/individual Score Reports Pkg 25, OL Audio CD, OL Examiner s (Form A), Ach Standard & Extended Test Record and Student Response Booklets with Individual Score Reports Pkg 25, Ach Standard & Extended Scoring Guide (Form A), Ach Extended Audio CD, Rolling Bag, and Luggage Grip WJ IV Complete Battery Plus (Achievement B, Cognitive, Oral Language) with Case $2, WJIV Technical Manual CD, OL Examiner s Training Workbook, OL Standard Test Book, OL Test Records w/individual Score Reports Pkg 25, OL Audio CD, OL Examiner s (Form B), Ach Standard & Extended Test Record and Student Response Booklets with Individual Score Reports Pkg 25, Ach Standard & Extended Scoring Guide (Form B), Ach Extended Audio CD, Rolling bag, Luggage grip WJ IV Complete Battery Plus (Achievement A, Cognitive, Oral Language) $2, WJ IV Technical Manual CD, OL Examiner s Training Workbook, OL Standard Test Book, OL Test Records w/individual Score Reports Pkg 25, OL Audio CD, OL Examiner s (Form A), Ach Standard & Extended Test Record and Student Response Booklets with Individual Score Reports Pkg 25, Ach Standard & Extended Scoring Guide (Form A), and Ach Extended Audio CD WJ IV Complete Battery Plus (Achievement B, Cognitive, Oral Language) with out Case $2, WJIV Technical Manual CD, OL Examiner s Training Workbook, OL Standard Test Book, OL Test Records w/individual Score Reports Pkg 25, OL Audio CD, OL Examiner s Manual, Cog Examiner s Training Workbook, Cog Standard and Extended Test Book, Cog Test Records and Individual Score Reports pk 25, Cog Student Response Books (Form B), Ach Standard & Extended Test Record and Student Response Booklets with Individual Score Reports Pkg 25, Ach Standard & Extended Scoring Guide (Form B), Ach Extended Audio CD Complete: Achievement and Cognitive WJ IV Complete Kit Form A (Achievement Form A, Cognitive) with Case $1, WJ IV Technical Manual CD, Cog Examiner s Training Workbook, Cog Standard and Extended Test Book, Cog Test Records and Individual Score Reports Pkg 25, Cog Student Response Books Pkg 25, Cog Scoring Guide, Cog Audio CD, Cog Examiner s Manual, Ach Examiner s Manual, Ach Examiner s Training Workbook, Ach Standard and Extended Test Book (Form A), Ach Standard and Extended Test Record and Student Response Booklets with Individual Score Reports Pkg 25, Ach Standard & Extended Scoring Guide (Form A), Ach Extended Audio CD, Rolling Bag, and Luggage Grip WJ IV Complete Kit Form A (Achievement Form A, Cognitive) $1, WJIV Technical Manual CD, Cog Examiner s Training Workbook, Cog Standard and Extended Test Book, Cog Test Records and Individual Score Reports Pkg 25, Cog Student Response Books Pkg 25, Cog Scoring Guide, Cog Audio CD, Cog Examiner s Manual, Ach Examiner s Manual, Ach Examiner s Training Workbook, Ach Standard and Extended Test Book (Form A), Ach Standard and Extended Test Record and Student Response Booklets with Individual Score Reports Pkg 25, Ach Standard & Extended Scoring Guide (Form A), and Ach Extended Audio CD Cognitive: WJ IV Cognitive Battery with Case $1, WJ IV Technical Manual CD, Cog Examiner s Training Workbook, Cog Standard and Extended Test Book, Cog Test Records and Individual Score Reports Pkg 25, Cog Student Response Books Pkg 25, Cog Scoring Guide, Cog Audio CD, Cog Examiner s Manual, Rolling Bag, and Luggage Grip WJ IV Cognitive Battery $1, WJ IV Technical Manual CD, Cog Examiner s Training Workbook, Cog Standard and Extended Test Book, Cog Test Records and Individual Score Reports Pkg 25, Cog Student Response Books Pkg 25, Cog Scoring Guide, Cog Audio CD, and Cog Examiner s Manual hmhco.com

3 Page 3 of 5 Test Records: WJ IV Cognitive Test Records with Individual Score Reports Pkg $ WJ IV Cognitive Response Book Pkg $63.85 WJ IV Achievement Standard and Extended Test with Individual Score Reports Form A Pkg $ WJ IV Achievement Standard and Extended Test Response Book Form A Pkg $63.85 WJ IV Achievement Standard and Extended Form A Test Records and Response Book with Individual Score Reports Pkg $ WJ IV Oral Test Records with Individual Score Reports Pkg $85.45 Training Kits: WJ IV University Training Package $ The WJ IV University Training Package is designed to help university professors train students how to use the Woodcock-Johnson IV. The DVD also includes presentation materials in PowerPoint format. (Includes the University Training DVD, tests of Achievement Examiner Training Workbook, tests of Cognitive Abilities Examiner Training Workbook, and tests of Oral Language Examiner Training Workbook.) WJ IV Self-Study Training Package $ Designed to help individuals learn how to administer and use the Woodcock-Johnson IV on their own. The DVD also contains pre- and post-tests to help examiners learning the WJ IV target their strengths and weaknesses. (Includes the Self-Study Training DVD, tests of Achievement Examiner Training Workbook, tests of Cognitive Abilities Examiner Training Workbook, and tests of Oral Language Examiner Training Workbook.) WJ IV Training Video Packages The WJ IV Training Videos feature actual test administration clips and include general administration rules, scoring procedures, and interpretive options. WJ IV Tests of Cognitive Abilities Training Video DVD Package (70 minutes) $89.60 (Includes the Examiner Training Workbook for the WJ IV tests of Cognitive Abilities.) WJ IV Examiner Training Workbooks Examiner Training workbooks for the WJ IV Tests of Cognitive Abilities Pkg $51.95 hmhco.com

4 Page 4 of 5 TRAINING OPTIONS Training is strongly recommended for purchases of the Woodcock-Johnson IV. For a comprehensive listing of training and professional courses, please visit our website All onsite trainings have a maximum capacity of 30 participants. Purchased trainings must be scheduled and delivered within one year of a signed order form. Initial Product Overview Training Offerings Live Web-Based Training: WJ IV Online Scoring and Reporting System Introductory Session $ This 1.5 hour session includes an overview of system navigation, direction on how to enter/edit examiner s and examinees, create caseload folders, generate and save reports as well as a description of resources available. WJ IV Tests of Cognitive Abilities: Administration of Standard Battery (Tests 1 10) $ This two hour session focuses on the administration of the Tests of Cognitive Abilities Standard Battery (Tests 1 10). WJ IV Tests of Cognitive Abilities: Administration of Extended Battery (Tests 11 18) $ This two hour session focuses on the administration of the Tests of Cognitive Abilities Extended Battery (Tests 11 18). WJ IV Tests of Cognitive Abilities: Levels of Interpretive Information $ This two hour session focuses on the use of clusters, the levels of information available, and variation and comparison procedures. Training Requirements Subtotal hmhco.com

5 Page 5 of 5 Onsite Training: WJ IV Tests of Cognitive Abilities: User Experience Training $2, This full day onsite session primarily focuses on the administration, scoring, and interpretation of the Tests of Cognitive Abilities. Background, development, organization will also be introduced as will the theoretical foundations, technical adequacy, and the range of interpretive data available. This is a 7 1/2 hour interactive training inclusive of lunch and break time. Woodcock Johnson IV Tests of Cognitive Abilities Advanced Interpretation Face to Face $2, This full day onsite training provides an in-depth review of interpreting the information that is derived from the WJ IV Tests of Cognitive Abilities. This is a 7 1/2 hour interactive training inclusive of lunch and break time. WJ IV What s New? Tests of Cognitive Abilities $2, This onsite session primarily focuses on the administration, scoring, and interpretation of the new tests in the Tests of Cognitive Abilities. Background, development, organization will also be introduced as will the theoretical foundations, technical adequacy, and the range of interpretive data available. Split into two identical 3.5 hour sessions, this option is perfect for organizations who want to provide half day trainings to two groups of participants in one day. WJ IV What s New? Cognitive and Achievement $2, This full day onsite session focuses on the administration, scoring, and interpretation of the new tests in the Tests of Cognitive Abilities and the Tests of Achievement. Background, development, and organization of the instruments as well as the theoretical foundations, technical adequacy, and the range of interpretive data available will be covered. This is a 7 1/2 hour interactive training inclusive of lunch and break time. WJ IV What s New? Cognitive and Oral Language $2, This full day onsite session focuses on the administration, scoring, and interpretation of the new tests in the Tests of Cognitive Abilities and the all-new Tests of Oral Language. Background, development, and organization of the instruments as well as the theoretical foundations, technical adequacy, and range of interpretive data available will be covered. This is a 7 1/2 hour interactive training inclusive of lunch and break time. For additional available training options, please contact your Assessment Account Executive or visit Please provide us with 3 options for your requested training dates. List dates in order of priority. Requested Training Dates: Training dates should be requested no earlier than 30 days from the date Houghton Mifflin Harcourt receives your order form and PO. Please understand that we will work with you to try to meet your requested training dates. The training dates you listed are not confirmed dates until one of our Clinical Training Representatives has a conference call with your Training Contact/Facilitator. All information on this order form must be completed in order to process your request. How to Place Your Order: Via riversideorders@hmhpub.com Via fax: Via phone: Via mail: HMH Customer Experience 3800 Golf Road, Suite 200 Rolling Meadows, IL Inquiries may be directed to: rpc_customer_service@hmhco.com For more information, please visit: hmhco.com/hmhassessment Note: To insure adequate processing time when submitting an expedited RUSH order, please phone in your order to Order Subtotal State Sales Tax Shipping Service Fee* Order Total * A shipping service fee is prepaid and added to the invoice. Estimate 10% ($10.00 minimum) for ground shipping; 15% ($10.00 minimum) for Second Day Air and shipping to AK and HI; 17% ($20.00 minimum) for Next Day Air shipping; and 25% for international shipments. Ground transportation available for AK and HI upon request. Prices quoted are subject to change without notice and do not include transportation charges unless otherwise stated. All orders will be filled at prices in effect upon receipt of your order. To obtain the most up to date pricing please call Houghton Mifflin Harcourt at or visit us online at hmhco.com. Internal Use Only: RPCGR21PB Woodcock-Johnson, WJ III, Compuscore, Woodcock Interpretation & Instructional Interventions Program, and WIIIP are trademarks or registered trademarks of Houghton Mifflin Harcourt Publishing Company. Windows is a registered trademark of Microsoft Corporation in the United States and/or other countries. Macintosh is a trademark of Apple Inc., registered in the U.S. and other countries. Houghton Mifflin Harcourt Publishing Company. All rights reserved. Printed in the U.S.A. 12/22/15 hmhco.com