220 



MEMOIRS NATIONAL ACADEMY OF SCIENCES. 



[Vol. XV, 



CONFIDENTIAL. The publication or reproduction of this document is forbidden 

 by the terms of the Espionage Act of June IS, 19)7, under penalty of a fine of not 

 more than $10,000 or imprisonment of not more than two years, or both. 



FORM 5 



GROUP EXAMINATION ALPHA 



GROUP NO... 



Name _ _ - Rank. . Age 



Company ., Regiment Ann.. Division... _ 



In what country or state born? Years in U. S.? _ „ Race 



Occupation.... Weekly Wages „ 



Schbohhg: Grades, 1. 2. 3. 4. 5. 6. 7. 8: High or Prep. School, Year 1. 2. 3. 4: College, Year 1. 2. 3. 4. 



TEST1 



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8. OOO MILITARY GUN CAMP 



9. 34-79-56-87-68-25-82-47-27-31-64-93-71-41-52-99 



10. 



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Division of Psychology, Medical Department U. S. A. 

 Authorized by the Surgeon Genera!, Feb. 8 1918, Edition, July 9, 1918. 200,000 



Fig. IS.— Group Examination Alpna, Form 5, Test 1, Oral Directions. 



