Resilience Scale Permission Request Form
Request permission to use a resilience scale for non-medical purposes. Please complete all fields accurately.
Full Name
*
First Name
Last Name
Organization
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Intended Use Description
*
Name of Resilience Scale/Instrument
*
Source, Author, or Copyright Holder (if known)
Will the scale be reproduced or quoted?
*
Reproduced
Quoted
Both
Not Applicable
Will the use be internal or external/public-facing?
*
Internal Use Only
External/Public-Facing
Requested Permission Scope
*
Acknowledgement: I confirm that I have the right to submit this request and agree to provide accurate information.
*
I agree
Submit Request
Should be Empty: