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Write down one way in which the advertisement limits the type of people who would apply for the flat.

Please state in which language the child is educated

Have you ever been legally married? (Please ring one number)

If mother not interviewed because she was ill, refused, etc., give reasons

Parent or relative attending with child.

How old do you expect to be when you leave college?

What is your present job?

How old do you expect to be when you leave school?

what is one more than three ?

If mother not interviewed because she refused, was ill, etc., give reasons

Which types of milk have you used regularly in drinks and added to breakfast cereals over the past three months? Milk A Other (specify)

Are any sections of the general consent form crossed out?

What Diploma/Certificate are you aiming for?

Please give the following details about this child's present class:- Number of children on the roll of the class? ... children

Is teenager in (or about to be in) a youth training scheme (YTS)?

Why will you be doing this job rather than any other?

If mother not interviewed because she was ill, refused, etc., please give reasons.

Date of present marriage ... (day) of ... (month) ... (year)

Does the mother (or mother figure) do paid work?

NAME OF TEACHER COMPLETING SECTIONS "C" TO "E" OF THIS QUESTIONNAIRE

Have you recently... ...been able to face up to problems?

Would you go to University if offered a place?

Has this child had any attacks of abdominal pain during the last year?

In the last 7 days have you had any of the following drinks? Spirits or liqueurs (e.g. whisky, gin, brandy)

Do you usually bring up any phlegm (spit from the chest) first thing in the morning in the winter?

How many months old was baby when it started? GERMAN MEASLES Age ... months

How many months old was baby when it started? SCARLET FEVER Age ... months

What type of antenatal preparation did the mother receive during this pregnancy? In preparation for labour (e.g. exercises, relaxation, etc.)

Date period ended: MONTH (Jan = 01, Feb = 02 etc) ... YEAR 19--

Please give your reasons for worrying

How many children have you had altogether?

In what ways was your school (or technical college) unsuccessful in preparing you for your present student life?

Have you been off work through accident or illness since you started work? since January 1963? (long enough to need a Doctor's cerficate)

Check whether they have brought their regular medicines with them and ask: Have you taken any medicines, prescribed or non-prescribed, in the last 24 hours?