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Please print CHILD BEHAVIOR CHECKLIST FOR AGES 6-18

PARENTSʼ USUAL TYPE OF WORK, even if not working now.

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(Please be specific — for example, auto mechanic, high school teacher,

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PARENT 1 (or FATHER)
TYPE OF WORK
Boy Girl PARENT 2 (or MOTHER)
TYPE OF WORK
TODAYʼS DATE

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Mo. ____ Day ____ Year ____
_________________________________________________
GRADE IN Please fill out this form to reflect your
view of the childʼs behavior even if other Your gender: Male Female

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SCHOOL ___________
people might not agree. Feel free to Your relation to the child:
print additional comments beside each

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NOT ATTENDING Biological Parent Step Parent Grandparent
item and in the space provided on page
SCHOOL 2. Be sure to answer all items. Adoptive Parent Foster Parent Other (specify)

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I. Please list the sports your child most likes Compared to others of the same Compared to others of the
to take part in. For example: swimming, age, about how much time does same age, how well does
baseball, skating, skate boarding, bike he/she spend in each? he/she do each one?
riding, fishing, etc.
Less Than More Than Donʼt Below Above Donʼt
None T HT
a. _________________________
Average Average Average Know Average Average Average Know

b. _________________________
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c. _________________________
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II. Please list your childʼs favorite hobbies, Compared to others of the same Compared to others of the same
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activities, and games, other than sports. For age, about how much time does age, how well does he/she do
example: video games, dolls, reading, piano, he/she spend in each? each one?
crafts, cars, computers, singing, etc. (Do not
include listening to radio, TV, or other media.)
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Less Than More Than Donʼt Below Above Donʼt

None Average Average Average Know Average Average Average Know
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a. _________________________
b. _________________________
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c. _________________________
III. Please list any organizations, clubs, teams, Compared to others of the same
or groups your child belongs to. age, how active is he/she in each?
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Less More Donʼt

None
Active Average Active Know
a. _________________________
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b. _________________________
c.
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Below Above Donʼt

None Average Average Average Know

a. _________________________
b. _________________________
Be sure you answered all
c. _________________________ items. Then see other side.

Copyright 2001 T. Achenbach UNAUTHORIZED COPYING IS ILLEGAL 1-15 Edition - 201

5-29-15 Edition - 301
ASEBA, University of Vermont
1 South Prospect St., Burlington, VT 05401-3456
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