Please enable JavaScript in your browser to complete this form.ALTO-100-201 Rater Qualification Questionnaire (RQQ)Instructions: Please provide all the information requested below. All sections must be completed in order to proceed to rater training activities.RATER AND SITE INFORMATIONRater Name *Rater Email *Site Number *Site Name *Site Address *Site Principal Investigator (PI) *Site Coordinator for ALTO-100-201Site Coordinator EmailEDUCATIONAL EXPERIENCEPlease help us establish your educational qualifications by listing all of your advanced degrees (i.e., degrees higher than a high school diploma), beginning with your most recent advanced degree.1. Degree Type *MDPhDNP/CNSDOPAPsyDMSMABSBASecond ChoiceRNMSNMSWLicense *YesNoNADegree SpecialtyYear Degree Received2. Degree TypeMDPhDNP/CNSDOPAPsyDMSMABSBASecond ChoiceRNMSNMSWLicenseYesNoNADegree SpecialtyYear Degree Received3. Degree TypeMDPhDNP/CNSDOPAPsyDMSMABSBASecond ChoiceRNMSNMSWLicenseYesNoNADegree SpecialtyYear Degree Received4. Degree TypeMDPhDNP/CNSDOPAPsyDMSMABSBASecond ChoiceRNMSNMSWLicenseYesNoNADegree SpecialtyYear Degree Received5. Other:LicenseYesNoNADegree SpecialtyYear Degree ReceivedEXPERIENCE WITH CLINICIAN-RATED ASSESSMENTS FOR ALTO-100-201Please help us to establish your rater experience with ALTO-100-201 clinician-rated assessments by providing the following information.1. Structured Clinical Interview for DSM-5 (SCID-5)Years of Experience *Estimated Number of Administrations in the past 6 months *I will be administering this assessment in the ALTO-100-201 study *YesNo2. Montgomery–Åsberg Depression Rating Scale (MADRS)Years of Experience *Estimated Number of Administrations in the past 6 months *I will be administering this assessment in the ALTO-100-201 study *YesNo3. Clinical Global Impression Scale – Severity (CGI-S)Years of Experience *Estimated Number of Administrations in the past 6 months *I will be administering this assessment in the ALTO-100-201 study *YesNo4. Concise Health Risk Tracking Clinician Rating scale (CHRT-C)Years of Experience *Estimated Number of Administrations in the past 6 monthsI will be administering this assessment in the ALTO-100-201 study *YesNo5. Antidepressant Treatment Response Questionnaire (ATRQ)Years of Experience *Estimated Number of Administrations in the past 6 monthsI will be administering this assessment in the ALTO-100-201 study *YesNoEXPERIENCE WITH OTHER CLINICIAN-RATED ASSESSMENTSPlease help us to establish your general rater experience by providing the following information1. In the space provided below, please list any other relevant clinician-rated assessment that you have administered in Depression studiesYears of ExperienceEstimated Number of Administrations in the past 6 months2. In the space provided below, please list any other relevant clinician-rated assessment that you have administered in Depression studiesYears of ExperienceEstimated Number of Administrations in the past 6 months3. In the space provided below, please list any other relevant clinician-rated assessment that you have administered in Depression studiesYears of ExperienceEstimated Number of Administrations in the past 6 months4. In the space provided below, please list any other relevant clinician-rated assessment that you have administered in Depression studiesYears of ExperienceEstimated Number of Administrations in the past 6 monthsCLINICAL AND RESEARCH EXPERIENCEPlease help us to establish your clinical and research experience with working in the field of depression.Area of Expertise1. I have experience working with individuals with Major Depressive Disorder (MDD) *YesNoIf YES, Years of ExperienceIf YES, Describe2. I have experience working with individuals with Depression (other than MDD) *YesNoIf YES, Years of ExperienceIf YES, Describe3. I have experience working on Clinical Trials *YesNoIf YES, Years of ExperienceIf YES, Describe4. I have experience working on Clinical Trials in Major Depressive Disorder (MDD) *YesNoIf YES, Years of ExperienceIf YES, Describe5. I have experience working on Clinical Trials in Depression (other than MDD) *YesNoIf YES, Years of ExperienceIf YES, DescribeSubmit