Instructions: Here áre soñe thngsleachers mlght say aboutlhetr stlde¡ls Pease tell!s abó!

ü¡rsstude¡t and whal he/she hás béen like

in lhe pas¡ Do¡tl¡ ReaC ea.h iiem carefu ly then ma¡k how weL ildescnbeslhiss¡udentorhowÍeque¡tly I has happened in the pastmonth

0 = ln the pasi month.lhs was ro¡ ¡r,é a¡ ár¡ aboLt rhls st0dent. r ¡éver (o¡serdóm) h¿ppene.
1-1.1-u"l o, -^ó justali¡ etrue"aa'.d .¡dór. r¡dooelóoo o .¿r
2 -11lóp¿. .-ó ¡\ 't
^c pevmucht¡ue aao' .i ss!dér. r'éppe
óoooór \ó qL -óD:
3 ¡ñ the pasl monlh.lhis was veryñ¿ch rrue aboutihs srudent Llhappened very oftei (!erynequenlr)
=
Pease crcle only one áóswerlor each item lt s lmporla¡tto respond to every ilem
Fo. i¡e¡ns Ihál you lnd dificult to answer please grve your besl guess.

,.'' .,. hating: 0: Notlrue at all(Never, Seldom) 2 = Pretty much true (Often, AuÉé a bit) '
. Ín the past month, th¡s was... 1 = J ust á little true (Occasionally) 3 = Ve¡y much true {Ve.y otten, Very freq!éntly)

0123
rdtask¡.: :: ': 0123
0123
0l 2. 3'
0t l:l
0 1 2 -1
012:l
0123
0t2l
: 0 1 ?' 3
0l
0
-0
123
123
r ,: O' 1 '2 3
0 r23
123
t2:l
l2:3
23
0123
0
. o. I .2: :l
0 113
0 123
0 123
I 2..:f,
(l 1)l
0 t23
0 1?l
.0 I 2. 1
0121
0i21
0121
0123
0123
0123
0123
0123
0123

Additional Qu€stio¡s:
40 Do you have any other co¡ccnis ¿boüt lhis studentl'
41. Wh¡l slrcDgths or skills does this stud€nr ha!c!

;i,::ir'tíli,*li:i:iL :l:\i;:lii.iJt'fitiliitl,,:ll:;l;i'Í,,iitti.:ll11ti:i);ti,Itl
I
=€MHS
 Bi.th Daie: / /

Admin Dale: / /

Scoring Grid

1. Foreach item, ta¡sfer the ci¡cled númber inio the unshaded box across each rcw
2. Sum the va ues in each @lumn and w.ile the totals iñ the Raw S@re boxes at the bottoñ of the orid

IN PR
1.012-3
z, 1000
3.0121
4. 1000
5. 0t2i
6, 0011.
7. 0123
.8, 0123
9. lt00
10. 0123
11. 0123
12, 0123
13. ll00
14. 0 I 2':.1
15. 0121
16, 0123'
11. 0123
18. 0123
19. 0001
20. 0123
21. 0011
22. 0t23
23. 3210
24. 0123
25. 0001
26- otz:L
27. 0123
2a- 0123
29. 0123
30. 012.3
31. 000i
32. 0123
33. 0011
34. 0001
35. 0123
36. 012,3
37. 0123
38. 001.1
39. ot27
RAW SCORES
HY

40. Do you have any othcr concerns about this srudent?

41. wlr¿l strcngths or skills does this srudent have?

Í'¿';ji,i:,'#l,lul:;il::i'1i:t::;:fiai'"sI:iili1;illl;rJ;H,itil;:,¿t;:li:t"'i:til'
=MHS
 f-r
o
a Male Profile: Ages 6-11
¡-{ 1 Usl¡g lhe Raw Scores fróm ttre Scorng Crid c rclelhe raw score ror each scae !ñderthe ¿pp:op¡¿(e s€ ¿¡¡
o 2 Fólowtlre row across ró elher olts de co úmn to fnd the I-scofe for each sca e
e age cot!mn

3 co¡nectthe ciced s.orcs vth slÉ tht .es to óbtá n the profie.
O
6)
F
,l
ca
a
r!
zz
c(-)

Response Style Analysis

I T.ansferthe Ráw Scoresfor bólh the Póstive mp¡esson lP ) a¡d
Negative iñpresslon {Nl)scaés irom the Scorng crid
2. l¡sertá checkmark ¡n the ftéF¡elve cudetne box fthe respo¡se - Possble n€qat.e resoonse sL!€

iliilil':illli,;:i:It,i:ilri:t';t::*,iiti*lfiii',.lll:illil'i:,it:rr,i.:',iit::i,)iilt.iltitl
=EMHS
 Bii{h Date: / /

Ase: G¡ade: Admin Dále: / /

t-r -

(n Male Profile: Ages 12-18

t-' l. Using the Raw Scores trom lhe Scorng Gr¡d. crcle the r¿w score for each s€e underthe app¡opnale scle ano age 6Lmn.
o 2 Folowlh€ row ac¡oss lo ethe¡ outslde column ló find lhe Iscoreioreach
3. Connect lhe cúced scores wllh stra ght lnes lo obiáin the proiile.

9
()
F
,]
ca
a
ú
r¡
z
zo
O

v
ü

Response Style Analysis

1 Transle¡ the Raw Scores for both lhe Posilve hpression (Pl) and
Negalve lmprcssio. (N ) scales froñ the Scor¡ng Grd.
Po55 be nesat!e response nllé
2 nseri a checkmark n the nterp¡elive GL de ne box illhe response -

i'¿:t'jj::illi,L:x:i:#ft:1:)ii:.,il1f;[,iri-i'-,lr]*:;r'i::lir,];ll j,ltir:,)ill.,"j:rjr"'
=MHS
 Bidh Dale:

l-r
o
at-{ Female Profile: Ages 6-11
1 Uslng the Raw Scores trom the Scorng Crid crclethe ¡aw sco¡e for each scae !nde.tlr€ apF@!ráie sc¿le and age coLmn
o 2. Fóiow Ihe row across 1o ether outsde column lo fi¡d lhe r-scóre for each scae.
3 Connect lhe c rcled scores wth straght liñes 1o obtaln lhe proíle
O
c)
F
:lao
a
r!
zz
o
O

c
¿

Response Style Analysis

Foss be pos'
1 Transter the Raw Scores for both lhe Posllve lmpressió. (Pl)and
-
Negalve lmpression (N )scales fom the S.ornq Grd. Possbe neo¿ive response ryL
2. nserta checknark n the nte¡prelve Gude ne box illhe respónse -
 Birlh Dáte: / /

Admn Date: / /

l-¡
O
-.1
a Female Profile: Ages 12-18
t-{ I Uslng the Raw Scores lrom the Scor ng Grid circ e the raw score lor each sca e under the appropriale scale and ¿ge co umn
o 2. Folow lhe ¡ow across to €Lther outsde cólüm¡ lo find lhe f-sco€ ior each
3 Coñnecl lhe circled scores wth slraght lnes to oblain lhe p¡ofle
C)
()
F
_l
a
añ
v)
r!
z
z
(J
O

o
¿

Response Style Analysis

1 Transler ihe Raw Scoes for both lhe Pós¡lve lmpressD¡ (Pl) ánd
Negalve lmpression (Nr) scales from lhe sco¡ins Grd. Poss b e neg¡t ve résponse style
2. l¡serta checkmark n the Lnterprelve Gudelne box ifthe response o ind caled I R¿w Score:5

i:t,;'jir:iLilllH:ri\:J:i:;$#'i'É,'fi"Tii",ilh:;if illi:,}lliil,\11i,lililil'
=MHS
 Notes

i"¡::':j,t:#l,I;lj:i::lL:r]#:fi#rfll;ft:':i';.lljll::ilT,:*;li.'l¡,liiili,)il*:lil'"
=EMHS