This document appears to be a response sheet for the Slosson Intelligence Test for children and adults. It includes fields to record the name, date of birth, examiner, chronological age, basal age, additional months, mental age, and intelligence quotient (IQ) of the test-taker. It also includes a table to convert scores to mental ages and credits months for higher scores.

1. PRUEBA DE INTELIGENCIA DE SLOSSON PARA NIÑOS Y ADULTOS
HOJA DE RESPUESTAS
NOMBRE:
_________________________________________________
FECHA DE APLICACIÓN:
___________________________________________
LUGAR DE APLICACIÓN:
_________________________________________________
FECHA DE NACIMIENTO:
___________________________________________
EXAMINADOR:
________________________________________________
EDAD CRONOLÓGICA: ________ ________ _____
AÑO MES DIA
EDAD BASAL: _______ MESES ADICIONALES: ________ EDAD MENTAL: ________MESES C. I. ________
CI=
EM
X100=
EC
PARA
CONVERTIR
1 – 12 2 – 24 3 – 36 4 – 48 5 – 60 6 – 72 7 – 84 8 – 96 9 –
108
10 –
120
11 –
132
12 –
144
13 –
156
14 –
168
15 –
180
16 –
192
17 –
204
18 –
216
19 –
228
20 –
240
21 –
252
22 -
264
23 –
276
24 –
288
1 / 2 MES DE CRÉDITO 1 MES DE CRÉDITO 2 MESES DE CRÉDITO 3 MESES DE CRÉDITO
A y M A y M A y M A y M A y M A y M A y M A y M A y M
0 – 0.5 1 – 0.0 2 – 0 4 – 0 5 – 0 9 – 0 13 – 0 16 – 0 22 – 0
0 – 1.0 1 – 0.5 2 – 1 4 – 1 5 – 2 9 – 2 13 – 2 16 – 3 22 – 3
0 – 1.5 1 – 1.0 2 – 2 4 – 2 5 – 4 9 – 4 13 – 4 16 – 6 22 – 6
0 – 2.0 1 – 1.5 2 – 3 4 – 3 5 – 6 9 – 6 13 – 6 16 – 9 22 – 9
0 – 2.5 1 – 2.0 2 – 4 4 – 4 5 – 8 9 – 8 13 – 8 17 – 0 23 – 0
0 – 3.0 1 – 2.5 2 – 5 4 – 5 5 – 10 9 – 10 13 – 10 17 – 3 23 – 3
0 – 3.5 1 – 3.0 2 – 6 4 – 6 6 – 0 10 – 0 14 – 0 17 – 6 23 – 6
0 – 4.0 1 – 3.5 2 – 7 4 – 7 6 – 2 10 – 2 14 – 2 17 – 9 23 – 9
0 – 4.5 1 – 4.0 2 – 8 4 – 8 6 – 4 10 – 4 14 – 4 18 – 0 24 – 0
0 – 5.0 1 – 4.5 2 – 9 4 – 9 6 – 6 10 – 6 14 – 6 18 – 3 24 – 3
0 – 5.5 1 – 5.0 2 – 10 4 – 10 6 – 8 10 – 8 14 – 8 18 – 6 24 – 6
0 – 6.0 1 – 5.5 2 – 11 4 – 11 6 – 10 10 – 10 14 – 10 18 – 9 24 – 9
0 – 6.5 1 – 6.0 3 – 0 7 – 0 11 – 0 15 – 0 19 – 0 25 – 0
0 – 7.0 1 – 6.5 3 – 1 7 – 2 11 – 2 15 – 2 19 – 3 25 – 3
0 – 7.5 1 – 7.0 3 – 2 7 – 4 11 – 4 15 – 4 19 – 6 25 – 6
0 – 8.0 1 – 7.5 3 – 3 7 – 6 11 – 6 15 – 6 19 – 9 25 – 9
0 – 8.5 1 – 8.0 3 – 4 7 – 8 11 – 8 15 – 8 20 – 0 26 – 0
0 – 9.0 1 – 8.5 3 – 5 7 – 10 11 – 10 15 – 10 20 – 3 26 – 3
0 – 9.5 1 – 9.0 3 – 6 8 – 0 12 – 0 20 – 6 26 – 6
0 – 10.0 1 – 9.5 3 – 7 8 – 2 12 – 2 20 – 9 26 – 9
0 – 10.5 1 – 10.0 3 – 8 8 – 4 12 – 4 21 – 0 27 – 0
0 – 11.0 1 – 10.5 3 – 9 8 – 6 12 – 6 21 – 3 27 – 3
0 – 11.5 1 – 11.0 3 – 10 8 – 8 12 – 8 21 – 6 27 – 6
1 – 11.5 3 – 11 8 – 10 12 – 10 21 – 9 27 – 9
.5 X _____ = _______ 1 X ______ = ______ 2 X _______ = _______ 3 X ______ = ______
De acuerdo con su edad cronológica debe de realizar _____ actividades, realiza____ omite______ agrega________
Su edad mental es _____ años_____ meses que su edad cronológica
Su CI corresponde a la clasificación de ____________________________ por lo que se sugiere: