Administrator’s Name:
Individual’s Name:
Date:
Age:
MaleFemale
NOTE: Do not analyze or debate over your response. To ensure accurate results, you must provide the first response that comes to your mind. This Questionnaire MUST only take you 8 to 10 minutes to complete.
Please provide a:
YOUTH CLINICAL
The 60 questions herein are copyrighted by N.C.C.A., S.A.C.C. and Drs.Arno for the sole purpose of generating an A.P.S. report. Any other use is a violation of copyright laws. Printed 2017 by N.C.C.A., S.A.C.C. of Sarasota,FL.
For each statement below, decide which of the following answers best applies to you. Place the number of the answer in the column at the left of the statement. Please be as honest as you can.
For this group of statements, please choose the best response that represents you: 1. Not at All 2. Very Seldom 3. On Occasion 4. From Time to Time 5. Many Times 6. Most of the Time
For this group of statements, please choose the best response that represents you: 1. No One 2. One or Two Kids 3. Some Kids 4. A Small Group of Kids 5. Most Kids 6. Almost Everyone