Music Experience Questionnaire

Researcher Agreement

Rev 10/06

 

Part 1: User name and contact information

 

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Name, title, and highest degree

 

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Mailing address

 

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City, state, zip (postal) code

 

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Telephone number and e-mail address

 

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Department/university/organization if not shown above

 

Part 2: Planned use of the MEQ

 

a. MEQ version requested (check one): 

___Full (141 item) MEQ

___Brief MEQ

 

b. Maximum number of participants to be tested with the MEQ __________

 

c. Title or subject of your intended study, followed by a brief description of participants and of the role of the MEQ

 

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Part 3: If you are currently a student, please answer the following questions

 

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Supervisor’s name and academic title

 

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Supervisor’s mailing address

 

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Supervisor’s city, state and zip (postal) code

 

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Supervisor’s telephone number and e-mail address

 

Part 4: Affirmation and signature

 

a. I affirm that the Music Experience Questionnaire (MEQ) will be used in keeping with ethical and professional standards for use of tests, as articulated in the Standards for Educational and Psychological Testing, most recent edition.

 

b. I agree to abide by the copyright of the MEQ. I will not reproduce MEQ question booklets or answer sheets beyond the authorized copying required to test the number of respondents specified above.  I agree that I am expressly prohibited from the following, unless additional written approval is granted by the authors of the MEQ: reproduction of items in research reports (including dissertations); and distribution of MEQ test materials, including booklets and scoring materials, by any means to other parties. I also agree not to use the MEQ materials for any for-profit purpose.

 

c. I agree to safeguard the MEQ from unsuitable or inappropriate use. To safeguard the security of the MEQ, I agree to store MEQ test materials, including test booklets and scoring materials, in secure (that is, locked) storage facilities accessible only to authorized personnel.

 

_______ If  this space is initialed by the researcher, I agree to donate a copy of raw research materials, with identifying information removed, as well as ASCII computer files (and documentation) and SPSS system files (or equivalent) on my resarch measures, to the MEQ archive directed by the authors of the MEQ.

 

 

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Researcher’s signature and date

 

Please mail your completed form to

Paul D. Werner, Ph.D.

Alliant International University, San Francisco Campus

One Beach Street, Suite 100     San Francisco, CA  94133  USA

Pwerner@alliant.edu