ࡱ> jli bjbj Ijjl0000v v v nTD,("JJJ+++++++$H- h/b,-^,"00JJEL,"""(08JJ+"+""#V*@hm+J 2Qb v p + m+b,0,+T0 qV<m+"0000Arno Profile System Response Form for Adults This form replaces the FIRO-B. The responses are used to generate an APS (Arno Profile System) report, formerly known as a Temperament Analysis Profile. Administrator s Name:  FORMTEXT       Individual s Name:  FORMTEXT       Date:  FORMTEXT  DATE \@ "MMMM d, yyyy" August 9, 2007August 9, 2007 Age:  FORMTEXT     Sex:  FORMDROPDOWN  Please provide a: Personnel  FORMCHECKBOX  Clinical  FORMCHECKBOX  Personal  FORMCHECKBOX  Note: Do not analyze or debate over your response. To ensure accurate results, you must provide the first response that comes to your mind. This Questionnaire MUST only take you 8 to 10 minutes to complete. The 54 questions contained herein are copyrighted by Care 4 America Inc.. They are reprinted by license agreement between CPP and the NCCA, SACC and Drs. Arno for the sole purpose of generating an APS report. Any other use is a violation of copyright laws and said license agreement.  For each statement below, decide which of the following answers best apply to you. Place the number of the answer in the box at the left of the statement (click in the gray, or Tab). Please be as honest as you can. 1 = never 2 = rarely 3 = occasionally 4 = sometimes 5 = often 6 = usually  FORMDROPDOWN __ I try to be with people.  FORMDROPDOWN __ I let other people decide what to do.  FORMDROPDOWN __ I join social groups.  FORMDROPDOWN __ I try to have close relationships with people.  FORMDROPDOWN __ I tend to join social organizations when I have an opportunity.  FORMDROPDOWN __ I let other people strongly influence my actions.  FORMDROPDOWN __ I try to be included in informal social activities.  FORMDROPDOWN __I try to have close, personal relationships with people.  FORMDROPDOWN __ I try to include other people in my plans.  FORMDROPDOWN __ I let other people control my actions.  FORMDROPDOWN __ I try to have people around me.  FORMDROPDOWN __ I try to get close and personal with people.  FORMDROPDOWN __ When people are doing things together, I tend to join them.  FORMDROPDOWN __ I am easily led by people.  FORMDROPDOWN __ I try to avoid being alone.  FORMDROPDOWN __ I try to participate in group activities.  For each of the next group of statements, choose one of the following answers: 1 = nobody2 = one or two people3 = a few people4 = some people5 = many people6 = most people  FORMDROPDOWN __ I try to be friendly to people.  FORMDROPDOWN __ I let other people decide what to do.  FORMDROPDOWN __ My personal relations with people are cool and distant.  FORMDROPDOWN __ I let other people take charge of things.  FORMDROPDOWN __ I try to have close relationships with people.  FORMDROPDOWN __ I let other people strongly influence my actions.  FORMDROPDOWN __ I try to get close and personal with people.  FORMDROPDOWN __ I let other people control my actions.  FORMDROPDOWN __ I act cool and distant with people.  FORMDROPDOWN __ I am easily led by people.  FORMDROPDOWN __ I try to have close, personal relationships with people. For each of the next group of statements, choose one of the following answers: 1 = nobody2 = one or two people3 = a few people4 = some people5 = many people6 = most people  FORMDROPDOWN __ I like people to invite me to things.  FORMDROPDOWN __ I like people to act close and personal with me.  FORMDROPDOWN __ I try to influence strongly other peoples actions.  FORMDROPDOWN __ I like people to invite me to join in their activities.  FORMDROPDOWN __ I like people to act close toward me.  FORMDROPDOWN __ I try to take charge of things when I am with people.  FORMDROPDOWN __ I like people to include me in their activities.  FORMDROPDOWN __ I like people to act cool and distant toward me.  FORMDROPDOWN __ I try to have other people do things the way I want them done.  FORMDROPDOWN __ I like people to ask me to participate in their discussions.  FORMDROPDOWN __ I like people to act friendly toward me.  FORMDROPDOWN __ I like people to invite me to participate in their activities.  FORMDROPDOWN __ I like people to act distant toward me.  For each of the next group of statements, choose one of the following answers: 1 = never 2 = rarely 3 = occasionally 4 = sometimes 5 = often 6 = usually  FORMDROPDOWN __ I try to be the dominant person when I am with people.  FORMDROPDOWN __ I like people to invite me to things.  FORMDROPDOWN __ I like people to act close toward me.  FORMDROPDOWN __ I try to have other people do things I want done.  FORMDROPDOWN __ I like people to invite me to join their activities.  FORMDROPDOWN __I like people to act cool and distant toward me.  FORMDROPDOWN __ I try to influence strongly other peoples actions.  FORMDROPDOWN __ I like people to include me in their activities.  FORMDROPDOWN __ I like people to act close and persona with me.  FORMDROPDOWN __ I try to take charge of things when Im with people.  FORMDROPDOWN __ I like people to invite me to participate in their activities  FORMDROPDOWN __ I like people to act distant toward me.  FORMDROPDOWN __ I try to have other people do things the way I want them done.  FORMDROPDOWN __ I take charge of things when Im with people  For Faxing: Print the data from a form in Word On the Tools menu, click Options, and then click the Print tab. Select the Print data only for forms check box, and then click OK. Click Print. FAX to the Fax Number provided. 1-866-531-1415 To Email: On the File menu, click Send To and select Mail Recipient. In your email program simply enter the address provided. This form will already be attached. 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l|)t$ tl(t< AdministratorNameDateText4SexRequestPersonnelRequestClinicalRequestPersonal Question1 question3 question4 question5 question6 question7 question8 question9 question10 question11 question12 question13 question14 question15 question16 question17 question18 question19 question20 question21 question22 question23 question24 question25 question26 question27 question28 question29 question30 question31 question32 question33 question34 question36 question37 question38 question39 question40 question41 question42 question43 question44 question45 question46 question47 question48 question49 question50 question51 question52 question53 question54 'r I#bb $ p 7 x   U .h<pL Q'lK  !"#$%&'()*+,-./0123456789:;k0Y3r"r 4  G * + e >xL-\a7| [  %)7 9 333333&kq 012_`aaHYZ["345arst"#$as # 5 o    6 H w  * + ,  + , - T f ->?@gxyz;LMN.o\]__ Pabc&789k|}~ J\&&LL Tom Carroll_C:\Documents and Settings\Tom Carroll\My Documents\care 4 america\Arno Profile System Adult.docRUE(nw?@ABCDEFGHIJKLMNOPQRSTUVWXZ[\]^_`bcdefghkRoot Entry FamData %,(1Table:<WordDocumentISummaryInformation(YDocumentSummaryInformation8aCompObjjObjectPoolaa  FMicrosoft Word Document MSWordDocWord.Document.89q