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Facilitator Qualification Form

Required for Facilitating Our Skillscope® 360 Assessment

The Center for Creative Leadership (CCL)® has established qualification guidelines for using our Skillscope® 360 assessment instrument. Our intent is to ensure its appropriate use by professionals who are trained and experienced in 360 feedback facilitation delivery. Therefore, completion of this form does not guarantee qualification to administer feedback on Skillscope®.

Completion and approval of this form are prerequisites to receiving feedback reports from CCL. You may submit this form online using the fields below, or in hard copy by printing out the Facilitator Qualification Form (PDF) and submitting it by mail or fax as indicated on the form. If you have questions regarding any of the required information, please contact us for assistance.

Assessment Resources for Facilitators

Upon approval of your request, you’ll receive access to our Assessment Resources site, which includes a user’s guide, presentation templates, and sample Skillscope® feedback reports.

For a more thorough orientation to 360 leadership assessments and facilitation, consider taking our Assessment Certification Course, or partnering with us to offer a custom assessment facilitation workshop for your organization — contact us to discuss options.

Policy on Use of Feedback Data

Our goal is to improve the quality of leadership through research, education, and the dissemination of knowledge. As part of our effort, we gather data on organizations and people. We have a very strong commitment to protect the rights, privacy, and dignity of every person who participates in a data collection activity. Therefore, to use our assessment instrument, you must adhere to the following statements. (Check each one as read:)

Qualification 1*
- * If I collect data on an individual, group, or organization, I will make myself available to facilitate feedback.
Qualification 2*
- * I will not facilitate individual feedback to any participant with whom I am in a direct reporting relationship.
Qualification 3*
- * Individual participants are the owners of their feedback data. Upon completion of a feedback session, I will issue my copy of the report to the participant.
Qualification 4*
- * CCL assessments were not developed for use in selection, compensation, or performance appraisal processes and I will not use them for any of these purposes.
Qualification 5*
- * Except where specifically noted and agreed upon prior to the start of the data collection process, I will maintain the confidentiality of the individual raters.
Agreement*
The below final agreement is required for submission of this qualification form. If you do not agree with any of the above qualification statements, you will not qualified to use of CCL assessment instruments. If you have any questions about these statements, please contact CCL.
- * I understand and agree to abide by the above statements for the use of all CCL assessments.
Approval of the below form qualifies you to use the following CCL assessment instruments:
- Skillscope® - Assesses managerial strengths and development needs of an individual.
Qualifications and Usage
Education*
Please indicate the highest level of education attained.
Other Education*

You indicated "Other" for Education. Please explain here.
Functional Level*
Other Functional Level*

You indicated "Other" for Functional Level. Please elaborate here.
Years of Managerial Experience*
Courses in test and measures, group process, organizational development, psychology, counseling, educational design, etc.:*
Experience with assessment instruments and/or facilitating feedback:*
Intended use of feedback results:*
Contact Information
First Name*
Last Name*
Job Title
Organization*
Address*
Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country
Work Phone*
Website (URL)

(e.g., http://www.ccl.org)
Email*
Enter Email Confirm Email
Preferred Email Format:
- Text
- HTML
Certification*
- * I certify that I am the person referenced above and that, to my knowledge, all the information provided is true and accurate.
Privacy Commitment
Center for Creative Leadership (CCL®) will use this information to ensure the best response to your inquiry. By submitting this form, you acknowledge that CCL may contact you.

At CCL, we care about your privacy. The information you share with us will only be used to better service you and in accordance with your consent. For more information, please refer to our Privacy Policy.
Phone
This field is for validation purposes and should be left unchanged.

Facilitator Qualification Form

Required for Facilitating Our Skillscope® 360 Assessment

Assessment Resources for Facilitators

Policy on Use of Feedback Data

Qualifications and Usage

Contact Information

Privacy Commitment