Research Request Form

If you are interested in using The Leadership Challenge or The Leadership Practices Inventory for your research, please fill out the form below. This form will be sent via email. Please make sure to fill out ALL fields in the form below.

Please Note: Receiving permission does NOT include free copies of the LPI or Leadership Challenge packages, books, surveys, or instruments.

You may also print, fill out, and fax the Research Request Form PDF document to Pfeiffer Editorial at 415-433-1711.

Information About You

	All Fields are Required
First Name:
Last Name:
Gender:		Select Your Gender Male Female
Street Address:
City:
State:		AA AB AE AK AL AR AS AZ BC CA CO CT DC DE FL FM FP GA GU HI IA ID IL IN KS KY LA MA MB MD ME MH MI MN MO MP MS MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE PR PW QC RI SC SD SK TN TX UT VA VI VT WA WI WV WY YK
Zip Code:
Country or Region:		United States Africa Argentina Australia Austria Belgium Brazil Bulgaria Canada Caribbean Central America Chile China Colombia Costa Rica Croatia Czech Republic Denmark Dominican Republic Estonia Finland France Germany Greece Guatemala Hong Kong Hungary India Indonesia Ireland Israel Italy Japan Korea Latvia Lithuania Luxembourg Malaysia Mexico Middle East Morocco Netherlands New Zealand Norway Panama Peru Philippines Poland Portugal Puerto Rico Romania Russian Federation Singapore Slovakia Slovenia South Africa Spain Sweden Switzerland Taiwan Thailand Turkey Ukraine United Kingdom United States Venezuela Vietnam
Phone:
Fax:
Email:

Use the pulldown menu's to indicate your current professional/educational status and then complete the corresponding fields. Choose all that apply.
Select A Status Undergraduate Graduate Doctoral Student Faculty Other
Major/Position:		Name of Institution/Company:
Select A Status Undergraduate Graduate Doctoral Student Faculty Other
Major/Position:		Name of Institution/Company:
Select A Status Undergraduate Graduate Doctoral Student Faculty Other
Major/Position:		Name of Institution/Company:
Select A Status Undergraduate Graduate Doctoral Student Faculty Other
Major/Position:		Name of Institution/Company:
Select A Status Undergraduate Graduate Doctoral Student Faculty Other
Major/Position:		Name of Institution/Company:

Information About The Study

Title of Study/Research:
Number of Participants:
Population Being Studied:
Institution Where Study is Occurring:
Scope of Project:
Anticipated Start Date:		(mm/dd/yyyy)
Anticipated Completion Date:		(mm/dd/yyyy)

Do you plan to use LPI product "Self" or "Observer" forms (purchased separately) for this research? :

Choose Your Option LPI Self LPI Observer LPI Self and LPI Observer Other

I would like more information about the forms