268 



MEMOIRS NATIONAL ACADEMY OF SCIENCES. 



[Vol. XV, 



POINT SCALE EXAMINATION 



Name 



Age___ 



Race... 



Station.. 



Co Regiment Arm _ — Division 



Where born , ~ - - Yrs. in U. S . 



Previous occupation - — - Weekly wages — 



Education: grade reached — - H. S.......— College..- 



Where educated , - — Yrs. in school 



Language ability , — — ,— - 



Disease history, personal and family — _ _ 



Remarks: 



Total Score, 

 Mental Age- 

 Rating 



Examiner's report; 



Signature of Examiner... _ _ —Date 



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

 Authorized by the Surgeon-General, Feb. 8, 1918. Edition, August 7, 1918 100,000. 



Fig. 65.— Point Scale Examination (first page). 



