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SERVICE S
Prof ile Shee t for G.A. S. (Form A or S)
Name:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Date:._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Age_ _ _ _ _ _ _ Sex:(Wr ite Mor F): _ _ _ _ _ _Occu patio n/Cla ss~- ------ ------ -
r
.. IF Sten Em Fa He Oc/Sc Se So Sten
II Score t -I, Score
\
I II 10 0 _:. .0.
l;i:;~if lI;·, ! 0·.:::.·::::·~::::::;=;:J::t: (!)
1:=:··.·-:-;,
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II
9, 0 ·:.:::.·(;,-_-::=:;;;(: 1:::: -.~
. ; ·..._._..:t;\.
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I:';: 1~
8 -·:0.-· .e.==/=
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e =··0 8
7 0 ·.·/•~!ti Ytl;!ijltt{ ··0- 0· 7
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6 0
1:•i:)~l'>•· I
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0. 6
I.. .. ··0·····
·.• ·,·•.. ....
'.I'.i!~:i> 0=:
• =:).sf:
5 =0=· ··\:I:: .. :.::-
_
0 5
4 0·. ., ¤>=·. .,\._:-=e..=:. Ii.: · :• ..t;\ .. .
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.
:
\:/ 0 ·® 4
. .:_:..••·
r:
·., : · =.-0 @=-· e 0· .
3 0· ·:·@=:·-//:
. -:

3
2 0· 0· . @.: 0 0 0 2
0 0 0 0 I
1 0
--
- -
-
Sten -I- Occupatio nal/ -f-Sten
) Score Emotiona l Family Health
Sten 1-2 = Excellent, Sten 3-4 = Good, Sten 5-6 = AYcrage, Sten 7-8

School Sexual
= Unsatisfac tor~·, Sten 9-10 = Poor
Social Score
• I lO<J:·J tL\,ll-\1 Ph· 6064.:n.
Copyright~- 1994. All righb. r1.-sc!r\"c!d by \Is PSY-COl\l SEl~\"ICES. 8-4. ~u-~. ::_J.Endaw. ":\.:w Ddhi ,..,