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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

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