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		<title>NICHQ Vanderbilt Assessment Scale &#8211; PARENT Informant Page</title>
		<link>https://browningmedicalgroup.com/nichq-vanderbilt-assessment-scale-parent-informant-page/</link>
		
		<dc:creator><![CDATA[Cindy]]></dc:creator>
		<pubDate>Thu, 12 Dec 2019 04:22:02 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<guid isPermaLink="false">https://browningmedicalgroup.com/?p=406</guid>

					<description><![CDATA[NICHQ Vanderbilt Assessment Scale &#8211; PARENT Informant NICHQ Vanderbilt Assessment Scale &#8211; PARENT Informant Today&#8217;s Date:* Date Format: MM slash DD slash YYYY Child&#8217;s Name:* First Last Date of Birth:* Date Format: MM slash DD slash YYYY Parent&#8217;s Name:* First Last Parent&#8217;s Phone Number:* Directions: Each rating should be considered in the context of what [&#8230;]]]></description>
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						        NICHQ Vanderbilt Assessment Scale - PARENT  Informant							</h3>
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			</li>
			<li class='gchoice gchoice_4_162_1'>
				<input name='input_162' type='radio' value='1'  id='choice_4_162_1'    />
				<label for='choice_4_162_1' id='label_4_162_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_162_2'>
				<input name='input_162' type='radio' value='2'  id='choice_4_162_2'    />
				<label for='choice_4_162_2' id='label_4_162_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_162_3'>
				<input name='input_162' type='radio' value='3'  id='choice_4_162_3'    />
				<label for='choice_4_162_3' id='label_4_162_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_163" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >7.  Loses things necessary for tasks or activities (toys, assignments, pencils, or books)<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_163'>
			<li class='gchoice gchoice_4_163_0'>
				<input name='input_163' type='radio' value='0'  id='choice_4_163_0'    />
				<label for='choice_4_163_0' id='label_4_163_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_163_1'>
				<input name='input_163' type='radio' value='1'  id='choice_4_163_1'    />
				<label for='choice_4_163_1' id='label_4_163_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_163_2'>
				<input name='input_163' type='radio' value='2'  id='choice_4_163_2'    />
				<label for='choice_4_163_2' id='label_4_163_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_163_3'>
				<input name='input_163' type='radio' value='3'  id='choice_4_163_3'    />
				<label for='choice_4_163_3' id='label_4_163_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_164" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >8.  Is easily distracted by noises or other stimuli.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_164'>
			<li class='gchoice gchoice_4_164_0'>
				<input name='input_164' type='radio' value='0'  id='choice_4_164_0'    />
				<label for='choice_4_164_0' id='label_4_164_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_164_1'>
				<input name='input_164' type='radio' value='1'  id='choice_4_164_1'    />
				<label for='choice_4_164_1' id='label_4_164_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_164_2'>
				<input name='input_164' type='radio' value='2'  id='choice_4_164_2'    />
				<label for='choice_4_164_2' id='label_4_164_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_164_3'>
				<input name='input_164' type='radio' value='3'  id='choice_4_164_3'    />
				<label for='choice_4_164_3' id='label_4_164_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_165" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >9. Is forgetful in daily activities.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_165'>
			<li class='gchoice gchoice_4_165_0'>
				<input name='input_165' type='radio' value='0'  id='choice_4_165_0'    />
				<label for='choice_4_165_0' id='label_4_165_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_165_1'>
				<input name='input_165' type='radio' value='1'  id='choice_4_165_1'    />
				<label for='choice_4_165_1' id='label_4_165_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_165_2'>
				<input name='input_165' type='radio' value='2'  id='choice_4_165_2'    />
				<label for='choice_4_165_2' id='label_4_165_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_165_3'>
				<input name='input_165' type='radio' value='3'  id='choice_4_165_3'    />
				<label for='choice_4_165_3' id='label_4_165_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_167" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >10. Fidgets with hands or feet or squirms in seat.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_167'>
			<li class='gchoice gchoice_4_167_0'>
				<input name='input_167' type='radio' value='0'  id='choice_4_167_0'    />
				<label for='choice_4_167_0' id='label_4_167_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_167_1'>
				<input name='input_167' type='radio' value='1'  id='choice_4_167_1'    />
				<label for='choice_4_167_1' id='label_4_167_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_167_2'>
				<input name='input_167' type='radio' value='2'  id='choice_4_167_2'    />
				<label for='choice_4_167_2' id='label_4_167_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_167_3'>
				<input name='input_167' type='radio' value='3'  id='choice_4_167_3'    />
				<label for='choice_4_167_3' id='label_4_167_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_168" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >11. Leaves seat when remaining seated is expected.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_168'>
			<li class='gchoice gchoice_4_168_0'>
				<input name='input_168' type='radio' value='0'  id='choice_4_168_0'    />
				<label for='choice_4_168_0' id='label_4_168_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_168_1'>
				<input name='input_168' type='radio' value='1'  id='choice_4_168_1'    />
				<label for='choice_4_168_1' id='label_4_168_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_168_2'>
				<input name='input_168' type='radio' value='2'  id='choice_4_168_2'    />
				<label for='choice_4_168_2' id='label_4_168_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_168_3'>
				<input name='input_168' type='radio' value='3'  id='choice_4_168_3'    />
				<label for='choice_4_168_3' id='label_4_168_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_169" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >12. Runs about or climbs too much when remaining seated is expected.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_169'>
			<li class='gchoice gchoice_4_169_0'>
				<input name='input_169' type='radio' value='0'  id='choice_4_169_0'    />
				<label for='choice_4_169_0' id='label_4_169_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_169_1'>
				<input name='input_169' type='radio' value='1'  id='choice_4_169_1'    />
				<label for='choice_4_169_1' id='label_4_169_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_169_2'>
				<input name='input_169' type='radio' value='2'  id='choice_4_169_2'    />
				<label for='choice_4_169_2' id='label_4_169_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_169_3'>
				<input name='input_169' type='radio' value='3'  id='choice_4_169_3'    />
				<label for='choice_4_169_3' id='label_4_169_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_170" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >13. Has difficulty playing or beginning quiet play activities.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_170'>
			<li class='gchoice gchoice_4_170_0'>
				<input name='input_170' type='radio' value='0'  id='choice_4_170_0'    />
				<label for='choice_4_170_0' id='label_4_170_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_170_1'>
				<input name='input_170' type='radio' value='1'  id='choice_4_170_1'    />
				<label for='choice_4_170_1' id='label_4_170_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_170_2'>
				<input name='input_170' type='radio' value='2'  id='choice_4_170_2'    />
				<label for='choice_4_170_2' id='label_4_170_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_170_3'>
				<input name='input_170' type='radio' value='3'  id='choice_4_170_3'    />
				<label for='choice_4_170_3' id='label_4_170_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_171" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >14. Is “on the go” or often acts as if “driven by a motor”.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_171'>
			<li class='gchoice gchoice_4_171_0'>
				<input name='input_171' type='radio' value='0'  id='choice_4_171_0'    />
				<label for='choice_4_171_0' id='label_4_171_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_171_1'>
				<input name='input_171' type='radio' value='1'  id='choice_4_171_1'    />
				<label for='choice_4_171_1' id='label_4_171_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_171_2'>
				<input name='input_171' type='radio' value='2'  id='choice_4_171_2'    />
				<label for='choice_4_171_2' id='label_4_171_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_171_3'>
				<input name='input_171' type='radio' value='3'  id='choice_4_171_3'    />
				<label for='choice_4_171_3' id='label_4_171_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_172" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >15. Talks too much.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_172'>
			<li class='gchoice gchoice_4_172_0'>
				<input name='input_172' type='radio' value='0'  id='choice_4_172_0'    />
				<label for='choice_4_172_0' id='label_4_172_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_172_1'>
				<input name='input_172' type='radio' value='1'  id='choice_4_172_1'    />
				<label for='choice_4_172_1' id='label_4_172_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_172_2'>
				<input name='input_172' type='radio' value='2'  id='choice_4_172_2'    />
				<label for='choice_4_172_2' id='label_4_172_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_172_3'>
				<input name='input_172' type='radio' value='3'  id='choice_4_172_3'    />
				<label for='choice_4_172_3' id='label_4_172_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_173" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >16. Blurts out answers before questions have been completed.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_173'>
			<li class='gchoice gchoice_4_173_0'>
				<input name='input_173' type='radio' value='0'  id='choice_4_173_0'    />
				<label for='choice_4_173_0' id='label_4_173_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_173_1'>
				<input name='input_173' type='radio' value='1'  id='choice_4_173_1'    />
				<label for='choice_4_173_1' id='label_4_173_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_173_2'>
				<input name='input_173' type='radio' value='2'  id='choice_4_173_2'    />
				<label for='choice_4_173_2' id='label_4_173_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_173_3'>
				<input name='input_173' type='radio' value='3'  id='choice_4_173_3'    />
				<label for='choice_4_173_3' id='label_4_173_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_174" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >17. Has difficulty waiting his or her turn.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_174'>
			<li class='gchoice gchoice_4_174_0'>
				<input name='input_174' type='radio' value='0'  id='choice_4_174_0'    />
				<label for='choice_4_174_0' id='label_4_174_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_174_1'>
				<input name='input_174' type='radio' value='1'  id='choice_4_174_1'    />
				<label for='choice_4_174_1' id='label_4_174_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_174_2'>
				<input name='input_174' type='radio' value='2'  id='choice_4_174_2'    />
				<label for='choice_4_174_2' id='label_4_174_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_174_3'>
				<input name='input_174' type='radio' value='3'  id='choice_4_174_3'    />
				<label for='choice_4_174_3' id='label_4_174_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_175" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >18. Interrupts or intrudes in on others’ conversations and/or activities.<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_175'>
			<li class='gchoice gchoice_4_175_0'>
				<input name='input_175' type='radio' value='0'  id='choice_4_175_0'    />
				<label for='choice_4_175_0' id='label_4_175_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_175_1'>
				<input name='input_175' type='radio' value='1'  id='choice_4_175_1'    />
				<label for='choice_4_175_1' id='label_4_175_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_175_2'>
				<input name='input_175' type='radio' value='2'  id='choice_4_175_2'    />
				<label for='choice_4_175_2' id='label_4_175_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_175_3'>
				<input name='input_175' type='radio' value='3'  id='choice_4_175_3'    />
				<label for='choice_4_175_3' id='label_4_175_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_176" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >19. Argues with adults<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_176'>
			<li class='gchoice gchoice_4_176_0'>
				<input name='input_176' type='radio' value='0'  id='choice_4_176_0'    />
				<label for='choice_4_176_0' id='label_4_176_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_176_1'>
				<input name='input_176' type='radio' value='1'  id='choice_4_176_1'    />
				<label for='choice_4_176_1' id='label_4_176_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_176_2'>
				<input name='input_176' type='radio' value='2'  id='choice_4_176_2'    />
				<label for='choice_4_176_2' id='label_4_176_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_176_3'>
				<input name='input_176' type='radio' value='3'  id='choice_4_176_3'    />
				<label for='choice_4_176_3' id='label_4_176_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_177" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >20. Loses temper<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_177'>
			<li class='gchoice gchoice_4_177_0'>
				<input name='input_177' type='radio' value='0'  id='choice_4_177_0'    />
				<label for='choice_4_177_0' id='label_4_177_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_177_1'>
				<input name='input_177' type='radio' value='1'  id='choice_4_177_1'    />
				<label for='choice_4_177_1' id='label_4_177_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_177_2'>
				<input name='input_177' type='radio' value='2'  id='choice_4_177_2'    />
				<label for='choice_4_177_2' id='label_4_177_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_177_3'>
				<input name='input_177' type='radio' value='3'  id='choice_4_177_3'    />
				<label for='choice_4_177_3' id='label_4_177_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_178" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >21. Actively defies or refuses to go along with adults’ requests or rules<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_178'>
			<li class='gchoice gchoice_4_178_0'>
				<input name='input_178' type='radio' value='0'  id='choice_4_178_0'    />
				<label for='choice_4_178_0' id='label_4_178_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_178_1'>
				<input name='input_178' type='radio' value='1'  id='choice_4_178_1'    />
				<label for='choice_4_178_1' id='label_4_178_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_178_2'>
				<input name='input_178' type='radio' value='2'  id='choice_4_178_2'    />
				<label for='choice_4_178_2' id='label_4_178_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_178_3'>
				<input name='input_178' type='radio' value='3'  id='choice_4_178_3'    />
				<label for='choice_4_178_3' id='label_4_178_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_179" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >22. Deliberately annoys people<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_179'>
			<li class='gchoice gchoice_4_179_0'>
				<input name='input_179' type='radio' value='0'  id='choice_4_179_0'    />
				<label for='choice_4_179_0' id='label_4_179_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_179_1'>
				<input name='input_179' type='radio' value='1'  id='choice_4_179_1'    />
				<label for='choice_4_179_1' id='label_4_179_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_179_2'>
				<input name='input_179' type='radio' value='2'  id='choice_4_179_2'    />
				<label for='choice_4_179_2' id='label_4_179_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_179_3'>
				<input name='input_179' type='radio' value='3'  id='choice_4_179_3'    />
				<label for='choice_4_179_3' id='label_4_179_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_180" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >23. Blames others for his or her mistakes or misbehaviors<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_180'>
			<li class='gchoice gchoice_4_180_0'>
				<input name='input_180' type='radio' value='0'  id='choice_4_180_0'    />
				<label for='choice_4_180_0' id='label_4_180_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_180_1'>
				<input name='input_180' type='radio' value='1'  id='choice_4_180_1'    />
				<label for='choice_4_180_1' id='label_4_180_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_180_2'>
				<input name='input_180' type='radio' value='2'  id='choice_4_180_2'    />
				<label for='choice_4_180_2' id='label_4_180_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_180_3'>
				<input name='input_180' type='radio' value='3'  id='choice_4_180_3'    />
				<label for='choice_4_180_3' id='label_4_180_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_181" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >24. Is touchy or easily annoyed by others<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_181'>
			<li class='gchoice gchoice_4_181_0'>
				<input name='input_181' type='radio' value='0'  id='choice_4_181_0'    />
				<label for='choice_4_181_0' id='label_4_181_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_181_1'>
				<input name='input_181' type='radio' value='1'  id='choice_4_181_1'    />
				<label for='choice_4_181_1' id='label_4_181_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_181_2'>
				<input name='input_181' type='radio' value='2'  id='choice_4_181_2'    />
				<label for='choice_4_181_2' id='label_4_181_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_181_3'>
				<input name='input_181' type='radio' value='3'  id='choice_4_181_3'    />
				<label for='choice_4_181_3' id='label_4_181_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_182" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >25. Is angry or resentful<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_182'>
			<li class='gchoice gchoice_4_182_0'>
				<input name='input_182' type='radio' value='0'  id='choice_4_182_0'    />
				<label for='choice_4_182_0' id='label_4_182_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_182_1'>
				<input name='input_182' type='radio' value='1'  id='choice_4_182_1'    />
				<label for='choice_4_182_1' id='label_4_182_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_182_2'>
				<input name='input_182' type='radio' value='2'  id='choice_4_182_2'    />
				<label for='choice_4_182_2' id='label_4_182_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_182_3'>
				<input name='input_182' type='radio' value='3'  id='choice_4_182_3'    />
				<label for='choice_4_182_3' id='label_4_182_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_183" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >26. Is spiteful and wants to get even<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_183'>
			<li class='gchoice gchoice_4_183_0'>
				<input name='input_183' type='radio' value='0'  id='choice_4_183_0'    />
				<label for='choice_4_183_0' id='label_4_183_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_183_1'>
				<input name='input_183' type='radio' value='1'  id='choice_4_183_1'    />
				<label for='choice_4_183_1' id='label_4_183_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_183_2'>
				<input name='input_183' type='radio' value='2'  id='choice_4_183_2'    />
				<label for='choice_4_183_2' id='label_4_183_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_183_3'>
				<input name='input_183' type='radio' value='3'  id='choice_4_183_3'    />
				<label for='choice_4_183_3' id='label_4_183_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_184" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >27. Bullies, threatens, or intimidates others<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_184'>
			<li class='gchoice gchoice_4_184_0'>
				<input name='input_184' type='radio' value='0'  id='choice_4_184_0'    />
				<label for='choice_4_184_0' id='label_4_184_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_184_1'>
				<input name='input_184' type='radio' value='1'  id='choice_4_184_1'    />
				<label for='choice_4_184_1' id='label_4_184_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_184_2'>
				<input name='input_184' type='radio' value='2'  id='choice_4_184_2'    />
				<label for='choice_4_184_2' id='label_4_184_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_184_3'>
				<input name='input_184' type='radio' value='3'  id='choice_4_184_3'    />
				<label for='choice_4_184_3' id='label_4_184_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_185" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >28. Starts physical fights<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_185'>
			<li class='gchoice gchoice_4_185_0'>
				<input name='input_185' type='radio' value='0'  id='choice_4_185_0'    />
				<label for='choice_4_185_0' id='label_4_185_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_185_1'>
				<input name='input_185' type='radio' value='1'  id='choice_4_185_1'    />
				<label for='choice_4_185_1' id='label_4_185_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_185_2'>
				<input name='input_185' type='radio' value='2'  id='choice_4_185_2'    />
				<label for='choice_4_185_2' id='label_4_185_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_185_3'>
				<input name='input_185' type='radio' value='3'  id='choice_4_185_3'    />
				<label for='choice_4_185_3' id='label_4_185_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_186" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >29. Lies to get out of trouble or to avoid obligations (ie, “cons” others)<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_186'>
			<li class='gchoice gchoice_4_186_0'>
				<input name='input_186' type='radio' value='0'  id='choice_4_186_0'    />
				<label for='choice_4_186_0' id='label_4_186_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_186_1'>
				<input name='input_186' type='radio' value='1'  id='choice_4_186_1'    />
				<label for='choice_4_186_1' id='label_4_186_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_186_2'>
				<input name='input_186' type='radio' value='2'  id='choice_4_186_2'    />
				<label for='choice_4_186_2' id='label_4_186_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_186_3'>
				<input name='input_186' type='radio' value='3'  id='choice_4_186_3'    />
				<label for='choice_4_186_3' id='label_4_186_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_187" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >30. Is truant from school (skips school) without permission<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_187'>
			<li class='gchoice gchoice_4_187_0'>
				<input name='input_187' type='radio' value='0'  id='choice_4_187_0'    />
				<label for='choice_4_187_0' id='label_4_187_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_187_1'>
				<input name='input_187' type='radio' value='1'  id='choice_4_187_1'    />
				<label for='choice_4_187_1' id='label_4_187_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_187_2'>
				<input name='input_187' type='radio' value='2'  id='choice_4_187_2'    />
				<label for='choice_4_187_2' id='label_4_187_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_187_3'>
				<input name='input_187' type='radio' value='3'  id='choice_4_187_3'    />
				<label for='choice_4_187_3' id='label_4_187_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_188" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >31. Is physically cruel to people<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_188'>
			<li class='gchoice gchoice_4_188_0'>
				<input name='input_188' type='radio' value='0'  id='choice_4_188_0'    />
				<label for='choice_4_188_0' id='label_4_188_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_188_1'>
				<input name='input_188' type='radio' value='1'  id='choice_4_188_1'    />
				<label for='choice_4_188_1' id='label_4_188_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_188_2'>
				<input name='input_188' type='radio' value='2'  id='choice_4_188_2'    />
				<label for='choice_4_188_2' id='label_4_188_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_188_3'>
				<input name='input_188' type='radio' value='3'  id='choice_4_188_3'    />
				<label for='choice_4_188_3' id='label_4_188_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_189" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >32. Has stolen things that have value<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_189'>
			<li class='gchoice gchoice_4_189_0'>
				<input name='input_189' type='radio' value='0'  id='choice_4_189_0'    />
				<label for='choice_4_189_0' id='label_4_189_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_189_1'>
				<input name='input_189' type='radio' value='1'  id='choice_4_189_1'    />
				<label for='choice_4_189_1' id='label_4_189_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_189_2'>
				<input name='input_189' type='radio' value='2'  id='choice_4_189_2'    />
				<label for='choice_4_189_2' id='label_4_189_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_189_3'>
				<input name='input_189' type='radio' value='3'  id='choice_4_189_3'    />
				<label for='choice_4_189_3' id='label_4_189_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_190" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >33. Deliberately destroys others’ property<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_190'>
			<li class='gchoice gchoice_4_190_0'>
				<input name='input_190' type='radio' value='0'  id='choice_4_190_0'    />
				<label for='choice_4_190_0' id='label_4_190_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_190_1'>
				<input name='input_190' type='radio' value='1'  id='choice_4_190_1'    />
				<label for='choice_4_190_1' id='label_4_190_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_190_2'>
				<input name='input_190' type='radio' value='2'  id='choice_4_190_2'    />
				<label for='choice_4_190_2' id='label_4_190_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_190_3'>
				<input name='input_190' type='radio' value='3'  id='choice_4_190_3'    />
				<label for='choice_4_190_3' id='label_4_190_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_191" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >34. Has used a weapon that can cause serious harm (bat, knife, brick, gun)<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_191'>
			<li class='gchoice gchoice_4_191_0'>
				<input name='input_191' type='radio' value='0'  id='choice_4_191_0'    />
				<label for='choice_4_191_0' id='label_4_191_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_191_1'>
				<input name='input_191' type='radio' value='1'  id='choice_4_191_1'    />
				<label for='choice_4_191_1' id='label_4_191_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_191_2'>
				<input name='input_191' type='radio' value='2'  id='choice_4_191_2'    />
				<label for='choice_4_191_2' id='label_4_191_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_191_3'>
				<input name='input_191' type='radio' value='3'  id='choice_4_191_3'    />
				<label for='choice_4_191_3' id='label_4_191_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_192" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >35. Is physically cruel to animals<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_192'>
			<li class='gchoice gchoice_4_192_0'>
				<input name='input_192' type='radio' value='0'  id='choice_4_192_0'    />
				<label for='choice_4_192_0' id='label_4_192_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_192_1'>
				<input name='input_192' type='radio' value='1'  id='choice_4_192_1'    />
				<label for='choice_4_192_1' id='label_4_192_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_192_2'>
				<input name='input_192' type='radio' value='2'  id='choice_4_192_2'    />
				<label for='choice_4_192_2' id='label_4_192_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_192_3'>
				<input name='input_192' type='radio' value='3'  id='choice_4_192_3'    />
				<label for='choice_4_192_3' id='label_4_192_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_193" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >36. Has deliberately set fires to cause damage<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_193'>
			<li class='gchoice gchoice_4_193_0'>
				<input name='input_193' type='radio' value='0'  id='choice_4_193_0'    />
				<label for='choice_4_193_0' id='label_4_193_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_193_1'>
				<input name='input_193' type='radio' value='1'  id='choice_4_193_1'    />
				<label for='choice_4_193_1' id='label_4_193_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_193_2'>
				<input name='input_193' type='radio' value='2'  id='choice_4_193_2'    />
				<label for='choice_4_193_2' id='label_4_193_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_193_3'>
				<input name='input_193' type='radio' value='3'  id='choice_4_193_3'    />
				<label for='choice_4_193_3' id='label_4_193_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_194" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >37. Has broken into someone else’s home, business, or car<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_194'>
			<li class='gchoice gchoice_4_194_0'>
				<input name='input_194' type='radio' value='0'  id='choice_4_194_0'    />
				<label for='choice_4_194_0' id='label_4_194_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_194_1'>
				<input name='input_194' type='radio' value='1'  id='choice_4_194_1'    />
				<label for='choice_4_194_1' id='label_4_194_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_194_2'>
				<input name='input_194' type='radio' value='2'  id='choice_4_194_2'    />
				<label for='choice_4_194_2' id='label_4_194_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_194_3'>
				<input name='input_194' type='radio' value='3'  id='choice_4_194_3'    />
				<label for='choice_4_194_3' id='label_4_194_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_195" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >38. Has stayed out at night without permission<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_195'>
			<li class='gchoice gchoice_4_195_0'>
				<input name='input_195' type='radio' value='0'  id='choice_4_195_0'    />
				<label for='choice_4_195_0' id='label_4_195_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_195_1'>
				<input name='input_195' type='radio' value='1'  id='choice_4_195_1'    />
				<label for='choice_4_195_1' id='label_4_195_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_195_2'>
				<input name='input_195' type='radio' value='2'  id='choice_4_195_2'    />
				<label for='choice_4_195_2' id='label_4_195_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_195_3'>
				<input name='input_195' type='radio' value='3'  id='choice_4_195_3'    />
				<label for='choice_4_195_3' id='label_4_195_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_196" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >39. Has run away from home overnight<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_196'>
			<li class='gchoice gchoice_4_196_0'>
				<input name='input_196' type='radio' value='0'  id='choice_4_196_0'    />
				<label for='choice_4_196_0' id='label_4_196_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_196_1'>
				<input name='input_196' type='radio' value='1'  id='choice_4_196_1'    />
				<label for='choice_4_196_1' id='label_4_196_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_196_2'>
				<input name='input_196' type='radio' value='2'  id='choice_4_196_2'    />
				<label for='choice_4_196_2' id='label_4_196_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_196_3'>
				<input name='input_196' type='radio' value='3'  id='choice_4_196_3'    />
				<label for='choice_4_196_3' id='label_4_196_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_197" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >40. Has forced someone into sexual activity<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_197'>
			<li class='gchoice gchoice_4_197_0'>
				<input name='input_197' type='radio' value='0'  id='choice_4_197_0'    />
				<label for='choice_4_197_0' id='label_4_197_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_197_1'>
				<input name='input_197' type='radio' value='1'  id='choice_4_197_1'    />
				<label for='choice_4_197_1' id='label_4_197_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_197_2'>
				<input name='input_197' type='radio' value='2'  id='choice_4_197_2'    />
				<label for='choice_4_197_2' id='label_4_197_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_197_3'>
				<input name='input_197' type='radio' value='3'  id='choice_4_197_3'    />
				<label for='choice_4_197_3' id='label_4_197_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_198" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >41. Is fearful, anxious, or worried<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_198'>
			<li class='gchoice gchoice_4_198_0'>
				<input name='input_198' type='radio' value='0'  id='choice_4_198_0'    />
				<label for='choice_4_198_0' id='label_4_198_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_198_1'>
				<input name='input_198' type='radio' value='1'  id='choice_4_198_1'    />
				<label for='choice_4_198_1' id='label_4_198_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_198_2'>
				<input name='input_198' type='radio' value='2'  id='choice_4_198_2'    />
				<label for='choice_4_198_2' id='label_4_198_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_198_3'>
				<input name='input_198' type='radio' value='3'  id='choice_4_198_3'    />
				<label for='choice_4_198_3' id='label_4_198_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_199" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >42. Is afraid to try new things for fear of making mistakes<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_199'>
			<li class='gchoice gchoice_4_199_0'>
				<input name='input_199' type='radio' value='0'  id='choice_4_199_0'    />
				<label for='choice_4_199_0' id='label_4_199_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_199_1'>
				<input name='input_199' type='radio' value='1'  id='choice_4_199_1'    />
				<label for='choice_4_199_1' id='label_4_199_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_199_2'>
				<input name='input_199' type='radio' value='2'  id='choice_4_199_2'    />
				<label for='choice_4_199_2' id='label_4_199_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_199_3'>
				<input name='input_199' type='radio' value='3'  id='choice_4_199_3'    />
				<label for='choice_4_199_3' id='label_4_199_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_200" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >43. Feels worthless or inferior<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_200'>
			<li class='gchoice gchoice_4_200_0'>
				<input name='input_200' type='radio' value='0'  id='choice_4_200_0'    />
				<label for='choice_4_200_0' id='label_4_200_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_200_1'>
				<input name='input_200' type='radio' value='1'  id='choice_4_200_1'    />
				<label for='choice_4_200_1' id='label_4_200_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_200_2'>
				<input name='input_200' type='radio' value='2'  id='choice_4_200_2'    />
				<label for='choice_4_200_2' id='label_4_200_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_200_3'>
				<input name='input_200' type='radio' value='3'  id='choice_4_200_3'    />
				<label for='choice_4_200_3' id='label_4_200_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_201" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >44. Blames self for problems, feels guilty<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_201'>
			<li class='gchoice gchoice_4_201_0'>
				<input name='input_201' type='radio' value='0'  id='choice_4_201_0'    />
				<label for='choice_4_201_0' id='label_4_201_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_201_1'>
				<input name='input_201' type='radio' value='1'  id='choice_4_201_1'    />
				<label for='choice_4_201_1' id='label_4_201_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_201_2'>
				<input name='input_201' type='radio' value='2'  id='choice_4_201_2'    />
				<label for='choice_4_201_2' id='label_4_201_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_201_3'>
				<input name='input_201' type='radio' value='3'  id='choice_4_201_3'    />
				<label for='choice_4_201_3' id='label_4_201_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_202" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >45. Feels lonely, unwanted, or unloved; complains that “no one loves him or her”<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_202'>
			<li class='gchoice gchoice_4_202_0'>
				<input name='input_202' type='radio' value='0'  id='choice_4_202_0'    />
				<label for='choice_4_202_0' id='label_4_202_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_202_1'>
				<input name='input_202' type='radio' value='1'  id='choice_4_202_1'    />
				<label for='choice_4_202_1' id='label_4_202_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_202_2'>
				<input name='input_202' type='radio' value='2'  id='choice_4_202_2'    />
				<label for='choice_4_202_2' id='label_4_202_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_202_3'>
				<input name='input_202' type='radio' value='3'  id='choice_4_202_3'    />
				<label for='choice_4_202_3' id='label_4_202_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_203" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >46. Is sad, unhappy, or depressed<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_203'>
			<li class='gchoice gchoice_4_203_0'>
				<input name='input_203' type='radio' value='0'  id='choice_4_203_0'    />
				<label for='choice_4_203_0' id='label_4_203_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_203_1'>
				<input name='input_203' type='radio' value='1'  id='choice_4_203_1'    />
				<label for='choice_4_203_1' id='label_4_203_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_203_2'>
				<input name='input_203' type='radio' value='2'  id='choice_4_203_2'    />
				<label for='choice_4_203_2' id='label_4_203_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_203_3'>
				<input name='input_203' type='radio' value='3'  id='choice_4_203_3'    />
				<label for='choice_4_203_3' id='label_4_203_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_204" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >47. Is self-conscious or easily embarrassed<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_204'>
			<li class='gchoice gchoice_4_204_0'>
				<input name='input_204' type='radio' value='0'  id='choice_4_204_0'    />
				<label for='choice_4_204_0' id='label_4_204_0' class='gform-field-label gform-field-label--type-inline'>0 - Never</label>
			</li>
			<li class='gchoice gchoice_4_204_1'>
				<input name='input_204' type='radio' value='1'  id='choice_4_204_1'    />
				<label for='choice_4_204_1' id='label_4_204_1' class='gform-field-label gform-field-label--type-inline'>1 - Occasionally</label>
			</li>
			<li class='gchoice gchoice_4_204_2'>
				<input name='input_204' type='radio' value='2'  id='choice_4_204_2'    />
				<label for='choice_4_204_2' id='label_4_204_2' class='gform-field-label gform-field-label--type-inline'>2 - Often</label>
			</li>
			<li class='gchoice gchoice_4_204_3'>
				<input name='input_204' type='radio' value='3'  id='choice_4_204_3'    />
				<label for='choice_4_204_3' id='label_4_204_3' class='gform-field-label gform-field-label--type-inline'>3 - Very Often</label>
			</li></ul></div></li><li id="field_4_66" class="gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><h2 class="gsection_title">Performance</h2></li><li id="field_4_205" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >48. Overall school performance<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_205'>
			<li class='gchoice gchoice_4_205_0'>
				<input name='input_205' type='radio' value='1'  id='choice_4_205_0'    />
				<label for='choice_4_205_0' id='label_4_205_0' class='gform-field-label gform-field-label--type-inline'>1 - Excellent</label>
			</li>
			<li class='gchoice gchoice_4_205_1'>
				<input name='input_205' type='radio' value='2'  id='choice_4_205_1'    />
				<label for='choice_4_205_1' id='label_4_205_1' class='gform-field-label gform-field-label--type-inline'>2 - Above Average</label>
			</li>
			<li class='gchoice gchoice_4_205_2'>
				<input name='input_205' type='radio' value='3'  id='choice_4_205_2'    />
				<label for='choice_4_205_2' id='label_4_205_2' class='gform-field-label gform-field-label--type-inline'>3 - Average</label>
			</li>
			<li class='gchoice gchoice_4_205_3'>
				<input name='input_205' type='radio' value='4'  id='choice_4_205_3'    />
				<label for='choice_4_205_3' id='label_4_205_3' class='gform-field-label gform-field-label--type-inline'>4 - Somewhat of a Problem</label>
			</li>
			<li class='gchoice gchoice_4_205_4'>
				<input name='input_205' type='radio' value='5'  id='choice_4_205_4'    />
				<label for='choice_4_205_4' id='label_4_205_4' class='gform-field-label gform-field-label--type-inline'>5 - Problematic</label>
			</li></ul></div></li><li id="field_4_206" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >49. Reading<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_206'>
			<li class='gchoice gchoice_4_206_0'>
				<input name='input_206' type='radio' value='1'  id='choice_4_206_0'    />
				<label for='choice_4_206_0' id='label_4_206_0' class='gform-field-label gform-field-label--type-inline'>1 - Excellent</label>
			</li>
			<li class='gchoice gchoice_4_206_1'>
				<input name='input_206' type='radio' value='2'  id='choice_4_206_1'    />
				<label for='choice_4_206_1' id='label_4_206_1' class='gform-field-label gform-field-label--type-inline'>2 - Above Average</label>
			</li>
			<li class='gchoice gchoice_4_206_2'>
				<input name='input_206' type='radio' value='3'  id='choice_4_206_2'    />
				<label for='choice_4_206_2' id='label_4_206_2' class='gform-field-label gform-field-label--type-inline'>3 - Average</label>
			</li>
			<li class='gchoice gchoice_4_206_3'>
				<input name='input_206' type='radio' value='4'  id='choice_4_206_3'    />
				<label for='choice_4_206_3' id='label_4_206_3' class='gform-field-label gform-field-label--type-inline'>4 - Somewhat of a Problem</label>
			</li>
			<li class='gchoice gchoice_4_206_4'>
				<input name='input_206' type='radio' value='5'  id='choice_4_206_4'    />
				<label for='choice_4_206_4' id='label_4_206_4' class='gform-field-label gform-field-label--type-inline'>5 - Problematic</label>
			</li></ul></div></li><li id="field_4_207" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >50. Writing<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_207'>
			<li class='gchoice gchoice_4_207_0'>
				<input name='input_207' type='radio' value='1'  id='choice_4_207_0'    />
				<label for='choice_4_207_0' id='label_4_207_0' class='gform-field-label gform-field-label--type-inline'>1 - Excellent</label>
			</li>
			<li class='gchoice gchoice_4_207_1'>
				<input name='input_207' type='radio' value='2'  id='choice_4_207_1'    />
				<label for='choice_4_207_1' id='label_4_207_1' class='gform-field-label gform-field-label--type-inline'>2 - Above Average</label>
			</li>
			<li class='gchoice gchoice_4_207_2'>
				<input name='input_207' type='radio' value='3'  id='choice_4_207_2'    />
				<label for='choice_4_207_2' id='label_4_207_2' class='gform-field-label gform-field-label--type-inline'>3 - Average</label>
			</li>
			<li class='gchoice gchoice_4_207_3'>
				<input name='input_207' type='radio' value='4'  id='choice_4_207_3'    />
				<label for='choice_4_207_3' id='label_4_207_3' class='gform-field-label gform-field-label--type-inline'>4 - Somewhat of a Problem</label>
			</li>
			<li class='gchoice gchoice_4_207_4'>
				<input name='input_207' type='radio' value='5'  id='choice_4_207_4'    />
				<label for='choice_4_207_4' id='label_4_207_4' class='gform-field-label gform-field-label--type-inline'>5 - Problematic</label>
			</li></ul></div></li><li id="field_4_208" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >51. Mathematics<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_208'>
			<li class='gchoice gchoice_4_208_0'>
				<input name='input_208' type='radio' value='1'  id='choice_4_208_0'    />
				<label for='choice_4_208_0' id='label_4_208_0' class='gform-field-label gform-field-label--type-inline'>1 - Excellent</label>
			</li>
			<li class='gchoice gchoice_4_208_1'>
				<input name='input_208' type='radio' value='2'  id='choice_4_208_1'    />
				<label for='choice_4_208_1' id='label_4_208_1' class='gform-field-label gform-field-label--type-inline'>2 - Above Average</label>
			</li>
			<li class='gchoice gchoice_4_208_2'>
				<input name='input_208' type='radio' value='3'  id='choice_4_208_2'    />
				<label for='choice_4_208_2' id='label_4_208_2' class='gform-field-label gform-field-label--type-inline'>3 - Average</label>
			</li>
			<li class='gchoice gchoice_4_208_3'>
				<input name='input_208' type='radio' value='4'  id='choice_4_208_3'    />
				<label for='choice_4_208_3' id='label_4_208_3' class='gform-field-label gform-field-label--type-inline'>4 - Somewhat of a Problem</label>
			</li>
			<li class='gchoice gchoice_4_208_4'>
				<input name='input_208' type='radio' value='5'  id='choice_4_208_4'    />
				<label for='choice_4_208_4' id='label_4_208_4' class='gform-field-label gform-field-label--type-inline'>5 - Problematic</label>
			</li></ul></div></li><li id="field_4_209" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >52. Relationship with parents<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_209'>
			<li class='gchoice gchoice_4_209_0'>
				<input name='input_209' type='radio' value='1'  id='choice_4_209_0'    />
				<label for='choice_4_209_0' id='label_4_209_0' class='gform-field-label gform-field-label--type-inline'>1 - Excellent</label>
			</li>
			<li class='gchoice gchoice_4_209_1'>
				<input name='input_209' type='radio' value='2'  id='choice_4_209_1'    />
				<label for='choice_4_209_1' id='label_4_209_1' class='gform-field-label gform-field-label--type-inline'>2 - Above Average</label>
			</li>
			<li class='gchoice gchoice_4_209_2'>
				<input name='input_209' type='radio' value='3'  id='choice_4_209_2'    />
				<label for='choice_4_209_2' id='label_4_209_2' class='gform-field-label gform-field-label--type-inline'>3 - Average</label>
			</li>
			<li class='gchoice gchoice_4_209_3'>
				<input name='input_209' type='radio' value='4'  id='choice_4_209_3'    />
				<label for='choice_4_209_3' id='label_4_209_3' class='gform-field-label gform-field-label--type-inline'>4 - Somewhat of a Problem</label>
			</li>
			<li class='gchoice gchoice_4_209_4'>
				<input name='input_209' type='radio' value='5'  id='choice_4_209_4'    />
				<label for='choice_4_209_4' id='label_4_209_4' class='gform-field-label gform-field-label--type-inline'>5 - Problematic</label>
			</li></ul></div></li><li id="field_4_210" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >53. Relationship with siblings<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_210'>
			<li class='gchoice gchoice_4_210_0'>
				<input name='input_210' type='radio' value='1'  id='choice_4_210_0'    />
				<label for='choice_4_210_0' id='label_4_210_0' class='gform-field-label gform-field-label--type-inline'>1 - Excellent</label>
			</li>
			<li class='gchoice gchoice_4_210_1'>
				<input name='input_210' type='radio' value='2'  id='choice_4_210_1'    />
				<label for='choice_4_210_1' id='label_4_210_1' class='gform-field-label gform-field-label--type-inline'>2 - Above Average</label>
			</li>
			<li class='gchoice gchoice_4_210_2'>
				<input name='input_210' type='radio' value='3'  id='choice_4_210_2'    />
				<label for='choice_4_210_2' id='label_4_210_2' class='gform-field-label gform-field-label--type-inline'>3 - Average</label>
			</li>
			<li class='gchoice gchoice_4_210_3'>
				<input name='input_210' type='radio' value='4'  id='choice_4_210_3'    />
				<label for='choice_4_210_3' id='label_4_210_3' class='gform-field-label gform-field-label--type-inline'>4 - Somewhat of a Problem</label>
			</li>
			<li class='gchoice gchoice_4_210_4'>
				<input name='input_210' type='radio' value='5'  id='choice_4_210_4'    />
				<label for='choice_4_210_4' id='label_4_210_4' class='gform-field-label gform-field-label--type-inline'>5 - Problematic</label>
			</li></ul></div></li><li id="field_4_211" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >54. Relationship with peers<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_211'>
			<li class='gchoice gchoice_4_211_0'>
				<input name='input_211' type='radio' value='1'  id='choice_4_211_0'    />
				<label for='choice_4_211_0' id='label_4_211_0' class='gform-field-label gform-field-label--type-inline'>1 - Excellent</label>
			</li>
			<li class='gchoice gchoice_4_211_1'>
				<input name='input_211' type='radio' value='2'  id='choice_4_211_1'    />
				<label for='choice_4_211_1' id='label_4_211_1' class='gform-field-label gform-field-label--type-inline'>2 - Above Average</label>
			</li>
			<li class='gchoice gchoice_4_211_2'>
				<input name='input_211' type='radio' value='3'  id='choice_4_211_2'    />
				<label for='choice_4_211_2' id='label_4_211_2' class='gform-field-label gform-field-label--type-inline'>3 - Average</label>
			</li>
			<li class='gchoice gchoice_4_211_3'>
				<input name='input_211' type='radio' value='4'  id='choice_4_211_3'    />
				<label for='choice_4_211_3' id='label_4_211_3' class='gform-field-label gform-field-label--type-inline'>4 - Somewhat of a Problem</label>
			</li>
			<li class='gchoice gchoice_4_211_4'>
				<input name='input_211' type='radio' value='5'  id='choice_4_211_4'    />
				<label for='choice_4_211_4' id='label_4_211_4' class='gform-field-label gform-field-label--type-inline'>5 - Problematic</label>
			</li></ul></div></li><li id="field_4_212" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' >55. Participation in organized activities (eg, teams)<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_4_212'>
			<li class='gchoice gchoice_4_212_0'>
				<input name='input_212' type='radio' value='1'  id='choice_4_212_0'    />
				<label for='choice_4_212_0' id='label_4_212_0' class='gform-field-label gform-field-label--type-inline'>1 - Excellent</label>
			</li>
			<li class='gchoice gchoice_4_212_1'>
				<input name='input_212' type='radio' value='2'  id='choice_4_212_1'    />
				<label for='choice_4_212_1' id='label_4_212_1' class='gform-field-label gform-field-label--type-inline'>2 - Above Average</label>
			</li>
			<li class='gchoice gchoice_4_212_2'>
				<input name='input_212' type='radio' value='3'  id='choice_4_212_2'    />
				<label for='choice_4_212_2' id='label_4_212_2' class='gform-field-label gform-field-label--type-inline'>3 - Average</label>
			</li>
			<li class='gchoice gchoice_4_212_3'>
				<input name='input_212' type='radio' value='4'  id='choice_4_212_3'    />
				<label for='choice_4_212_3' id='label_4_212_3' class='gform-field-label gform-field-label--type-inline'>4 - Somewhat of a Problem</label>
			</li>
			<li class='gchoice gchoice_4_212_4'>
				<input name='input_212' type='radio' value='5'  id='choice_4_212_4'    />
				<label for='choice_4_212_4' id='label_4_212_4' class='gform-field-label gform-field-label--type-inline'>5 - Problematic</label>
			</li></ul></div></li><li id="field_4_75" class="gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible"  ><label class='gfield_label gform-field-label' for='input_4_75'>Comments:</label><div class='ginput_container ginput_container_textarea'><textarea name='input_75' id='input_4_75' class='textarea medium'      aria-invalid="false"   rows='10' cols='50'></textarea></div></li></ul></div>
        <div class='gform-footer gform_footer top_label'>  
            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_4' value='postback' />
            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_4' id='gform_theme_4' value='legacy' />
            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_4' id='gform_style_settings_4' value='' />
            <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='4' />
            
            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='TXflHPDVBkT/tdFEiQfMocLIR23prwcg6j8YmOqFEpkXMi5q6In9K2Yj10mEehxjh3l+pFdru7F5Cc7C3bik0+rBgOCVSX3R5Y/9cSJKzKpaXqk=' />
            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' />
            <input type='hidden' class='gform_hidden' name='state_4' value='WyJbXSIsIjUzNGNlMmJhNmNmOWRhMjM3ZjkwZDczOTk0MTdkMzI5Il0=' />
            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_4' id='gform_target_page_number_4' value='0' />
            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_4' id='gform_source_page_number_4' value='1' />
            <input type='hidden' name='gform_field_values' value='' />
            
        </div>
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