286 



MEMOIRS NATIONAL ACADEMY OF SCIENCES. 



[VOL. XV, 



Section 13. — Report blanks. 



The following report blanks were used during the preliminary examinations in the fall 

 of 1917: 



1. Psychological record (individual filing card). 



2. Call list for individual psychological examination. 



3. Report of psychological examination. 



4. Summary of psychological examinations. 



The following revisions and additional blanks were printed in April, 1918, for use in the 

 regular examination of recruits: 



1. Psychological record. 



2. Report of psychological examination. 



3. Psychological report form. 



4. Weekly report form. 



PSYCHOLOGICAL RECORD 



INDIVIDUAL FILING CARD 



NAME. _ 



CO BAT. REG.... 



BIRTHPLACE .... _...._ 



YRS. INU. S- RACE 



OCCUP. , 



SCHOOLING: GRADES _; 



AGE 



DIV 



WKLY WAGES 



H.S,„ COLL. 



LITERACY: H.S. 8 6 4 



INTEL. RATING: ABC 



2 

 D 



O 

 E 



REMARKS : 



Fig. 70.— Filing Card for Permanent Becord of Psychological Examination. (Preliminary form.) 



