Public
reporting burden of this collection of information is estimated to
average 10 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and
a person is not required to respond to a collection of information
unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this
burden to CDC/ATSDR Information Clearance Officer; 1600 Clifton Road
NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (???).
OMB
No: ???:
Exp Date: ??? _____________________
Vanderbilt Rating Scale
Each rating should be considered in the context of what is appropriate for the age of your child and should reflect your child’s behavior in the last 6 months. Please, (1) fill in only one bubble (answer) per question, (2) use a black or blue pen to complete the forms, and (3) do not write or place any stray marks on the forms except where specified. Thank you.
BEHAVIOR: |
Never |
Occasionally |
Often |
Very Often |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
|
O |
O |
O |
O |
Please turn over and answer questions on back of page.
BEHAVIOR: |
Never |
Occasionally |
Often |
Very Often |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
|
O |
O |
O |
O |
|
|||||
PERFORMANCE: |
Problematic |
|
Average |
|
Above Average |
|||||
|
O |
O |
O |
O |
O |
|||||
|
O |
O |
O |
O |
O |
|||||
|
O |
O |
O |
O |
O |
|||||
|
O |
O |
O |
O |
O |
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|
O |
O |
O |
O |
O |
|||||
|
O |
O |
O |
O |
O |
|||||
|
O |
O |
O |
O |
O |
|||||
|
O |
O |
O |
O |
O |
FOR STUDY USE ONLY |
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ID Number |
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Date Interviewed |
Month Day Year |
Interviewed by |
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The
End.
File Type | application/msword |
File Title | VANDERBILT EVALUATION TEACHER RATING SCALE (VETRS) – INITIAL |
Author | Melissa Doffing |
Last Modified By | fps8-su |
File Modified | 2007-03-19 |
File Created | 2007-03-16 |