NORTHWESTERN UNIVERSITY

College of Arts and Sciences

Department of Social Sciences and Humanities

PSYCHOLOGICAL EVALUATION REPORT

Personal Information
Name:
Age:
Date of Birth:
Sex:
Educational Level:
Source of Referral: Who referred you? (you can put someone else or yourself here)
Reason for Referral: Psychological Evaluation

Tests Administered Date of Examination

1. Full Scale IQ Test
2. Multifactor General Knowledge Test
3. Your choice of personality test
4. Your choice of personality test

Background Information
>Behaviors observed at home in school and in your daily life in general

Test Results and Interpretation

A. Intellectual Functioning
B. Social and Emotional Functioning or Personality and Emotional Functioning

> State here your scores in the test (in each scales of the test if possible) as well as
the interpretation of the scores (what do the scores mean?)
> Traits/skills that are common to the tests you have taken must be emphasized
here. This means that these traits are most likely to manifest in your behavior or
overall personality.
> Discuss what these results imply to your daily functioning. Do these results make
you sustainable? Will these make you more maladpative/maladjusted? Does the result
of the assessment explain your current behavior or experiences?

Summary
 Discuss here your conceptualization of the case
 This part is a comprehensive report on the functioning of the client based on
the test results.

Recommendations
> What do you recommend to yourself to improve or sustain your current
functioning? You can recommend seeking for professional help such as counseling or
psychotherapy. Recommend activities (specify the activities) to improve well-being.

(Signature)
(Your Name)
Psychologist