Section 1. Identifying Information
Name Wororimpaiment Yes C]_—no F)
Female 1 Male C)— Grade Type
Year Month Day_—_—Langunge Spoken
Date Teneo shoot
Date oft framers Nine 2
fae eines THe
Section 2, Record 07 Scores
Tonal Vu
tow ter Percentie ae Tieto
Score ‘nde ta Descriptive Rating gent compton
Section 3. Descriptive Ratings
Vina
Fertile Wetor ercetage ot
rank Indes Deserptive Rating Population Incuded
have | Cie Comet Response
|__| Design 6 Nemo Yes=T
tem 40; Thre cubes are present each wth thre vise aces ° 1
Noe: ter 40 cored 0 sore allremainng tems fr Design 620.
tem 4t For each cube fice (onal hee cube) thetines on opposite sis are pallor nearly
paral. ° '
wer 4: Each ede fice fn al three cues has four cll cere comers: ° 1
tem 4%: Thelines mang up the sides ofeach ube ae al elavely straight ight curvatures re
ceptable) with no cee angles present inary ine. “ ‘i
em 44: The thee ces ae the seme ot approximately the same size. thelaest cube iso more
than larger han the smallest cube) “ 1
Item 4s: The ed ofthe straightline: meet with no por vers of moe than ain oo