revised 9/2003 AGREEMENT FORM

I understand that the test materials provided by the Authors of the Facial Action Coding System are on loan and that all of these materials are to be returned and all copies destroyed after I finish the FACS Final Test and I have had time to review the feedback from the Authors and their collaborators about my scoring. I will return or destroy all copies of this video no later than two months after I receive it, or no later than one month after receiving the feedback about my scoring, if this period exceeds two months. 

I understand that I may not distribute this videotape for any purpose or use whatsoever. I understand that this videotape is to be used solely for the Final Test, by me and by any assistants or students who learn FACS with me. I agree not to use this videotape in any research activity. I agree not to allow this videotape or any portion of it to be used in any other activity not mentioned, with the sole exception of the one time use for the Final Test in FACS. I understand that these restrictions on the videotape have been taken to help the developers of FACS monitor proficiency achieved by those who learn FACS.

Date_____________________ Signed______________________________

Title ______________________________

Institution_________________________

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Witnesses:

Date_______ Name (Print)_________________Address_________________

Signature____________________ _______________________

Date_______ Name (Print)_________________Address_________________

Signature____________________ _______________________

Revised 6/29/92 FACS TEST ORDERING CHECK LIST

Address to which the FACS Final Test is shipped:

Name:__________________________________ Telephone:_(___)_________

Institution:___________________________ Email:___________________

Department:____________________________

Street:________________________________

City:__________________________________

State:_____________________Zip:________

PRINCIPAL INVESTIGATOR ON PROJECT_________________________

NUMBER OF TRAINEES TAKING THE TEST:____

Full Name(s) of trainee(s)

______________________________________________________

______________________________________________________

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____SIGNED AGREEMENT TO THE USE OF THE FACS TEST MATERIALS MUST BE ENCLOSED