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* 1. Insert your full name

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* 2. Your Organisation/Institution

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* 3. Your PhD Supervisor's name (if applicable)

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* 4. Insert intended title of thesis here (if applicable)

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* 5. Please describe your intended uses of the CCI

The University of Worcester is willing to grant agreement for you to use the CCI questionnaire, on the condition that you agree to the following conditions. Please read through the following and tick 'yes' to the statements to confirm your compliance with the conditions of use of the CCI.

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* 6. I confirm that I understand, and will comply with, the following five conditions:

  Yes No
That I will not use the CCI for commercial purposes
That the results of the research (e.g. validation, reliability analysis, factor analysis, any other statistical analysis) will be shared with the University of Worcester
That the CCI will only be used by myself, for use within the project stated above
That the University of Worcester will be given the appropriate credit for the CCI, by using the following reference (or, in an equivalent format): Francis-Smythe, J.A., Haase,S. Steele,C. Thomas, E. (2012) Development And Validation
That the University of Worcester will be informed of any further publication arising from research using the TPI

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