BEHAVIORAL CHECKLIST

Please indicate for each item a YES if the item is characteristic of the child, and a NO if the item
does not describe the child.

SCHOOL...... -… TEACHER'S NAME— — -...... CHILD'S NAME-------

1. The child's schoolwork is at a consistent level with the majority of his classmates. ---------
2. The child is able to play well with other children. -----
3. The child is reasonably spontaneous and outgoing. -------
4. The child relates well to peers and adults. --------
5. The child is liked and respected by peers. ---------
6. The child is effective and productive in the classroom. — --
7. The child is responsible and can be depended upon. ------
8. The child is kind and helpful to the teacher and classmates. ---
9. The child is able to share his possessions with others, — -—
10. The child shows reasonable control over his emotions. --------
11. The child is relatively free from fears, tensions, and nervous mannerisms. ---------

Please indicate below any additional information.