PRECLEAR: __________________________ AUDITOR: __________________________
Time period covered
Date assessment started
1st Run: __________ __________
2nd Run: __________ __________
3rd Run: __________ __________
1. Pc’s full name.
2. Other names pc has used.
3. Names pc has been called or given.
4. Name pc prefers.
5. Names pc would rather have and rather not have.
6. Titles and degrees.
7. (Other)
1. Current major position.
2. Other current positions and titles.
3. Positions pc would like to have.
4. Positions pc would rather not have.
5. Past history of the above.
6. (Other)
1. What pc is mainly being.
2. What pc would rather be.
3. What pc would rather not be.
4. What pc has mainly been.
5. Would rather not have been.
6. Would rather have been.
7. Other identities pc has been and is being.
8. (Other)
1. Education level attained.
2. Recent courses or training.
3. The importance of education.
4. Past education/training.
5. Early education/training.
6. Self-education.
7. (Other)
1. Current job or work.
2. Other earning capacity.
3. What receives by working.
4. Area of influence.
5. Responsibilities.
6. (Other)
1. Hobbies.
2. Other interests.
3. Skills.
4. Major skill.
5. Unusual interests.
6. Future interests.
7. Past interests, hobbies and skills.
8. (Other)
1. Things pc feels compelled to do.
2. Must prevent himself from doing.
3. Fears.
4. Bad habits.
5. Other habits.
6. Unusual precautions.
7. (Other)
1. What pc mainly does.
2. What pc would rather do.
3. What pc would rather not do.
4. Has mainly done in past.
5. Would rather not have done.
6. Would rather have done.
7. Other things pc is doing and has done.
8. Pc’s activity level.
9. Pc’s necessity level.
10. (Other)
1. Genetic line.
2. Body condition.
3. Body defects.
4. Exercise.
5. Body care.
6. Eating and diet.
7. Accidents.
8. Illness.
9. Medications.
10. Drugs.
11. Medical care.
12. Glasses.
13. Artificial body parts.
14. Relationship to body.
15. ARC with body.
16. Birth.
17. Death.
18. (Other)
1. Where living.
2. Where working.
3. Where normally visits.
4. Where friends live.
5. Where goes for recreation.
6. Area of everyday environment.
7. Area of monthly environment.
8. Area of yearly environment.
9. Area of this life environment.
10. Birth place.
11. Location of definition of past areas of residence and activity.
12. (Other)
1. Appointments.
2. Has enough time.
3. Has too much time.
4. Has not enough time.
5. Is too young.
6. Is too old.
7. Is too fast.
8. Is too slow.
9. (Other)
1. Personal effects.
2. Clothes.
3. Machines.
4. Books.
5. Money.
6. Property.
7. Business interests.
8. Stocks and bonds.
9. Public property.
10. Cities and countryside.
11. Other people’s property.
12. Saves things.
13. Wastes things.
14. Destroys things.
15. Creates things.
16. Handling and control of other dynamics.
17. Handling and control of MEST.
18. (Other)
1. What pc mainly has.
2. What pc would rather have.
3. What pc would rather not have.
4. Has mainly had in the past.
5. Would rather not have had.
6. Would rather have had.
7. Other things pc has and has had.
8. Pc’s ability to have.
9. (Other)
1. Mental condition.
2. Mental defects.
3. Medical/psychiatric treatment.
4. Electric shock.
5. Brain surgery.
6. Treatment with drugs.
7. Psychoanalysis.
8. Mystical or occult exercises.
9. Hypnotism.
10. Self-analysis.
11. Self-auditing.
12. Squirrel auditing.
13. Psychology.
14. Other mental treatment.
15. (Other)
1. Current auditing.
2. Recent auditors.
3. Processes run.
4. Recent auditing gains.
5. Recent auditing loses.
6. Present processing goals.
7. Past auditing history.
8. (Other)
1. __________
2. __________
3. __________
4. __________
5. __________
6. __________
7. __________
8. __________
9. __________
10. __________
1. Relationship with father.
2. Relationship with mother.
3. Relationship with foster parents or other guardians.
4. Who pc considers to be closest to acting as parents.
5. (Other)
1. Brothers.
2. Sisters.
3. Aunts and uncles.
4. Grandparents.
5. Cousins.
6. Other relatives.
7. (Other)
1. Wife or husband.
2. Children.
3. Spouse’s family.
4. Other wives or husbands.
5. Children by someone other than spouse.
6. (Other)
1. Sex with spouse.
2. Extramarital relations.
3. Premarital relations.
4. Sex with opposite sex.
5. Past history of above.
6. (Other)
1. Types of sex.
2. Homosexuality.
3. Sex with animals.
4. Fetishes.
5. Sex with children.
6. Unusual sex.
7. Absence of sex.
8. Substitutions for sex.
9. Masturbation.
10. Areas related to sex.
11. (Other)
1. Procreation.
2. Contraception.
3. Sex for pleasure.
4. Babies.
5. Childbearing.
6. Pregnancy.
7. Abortion.
8. Miscarriage.
9. Family planning.
10. Family survival.
11. (Other)
1. __________
2. __________
3. __________
4. __________
5. __________
6. __________
7. __________
8. __________
9. __________
10. __________
1. Close friends.
2. Old friends.
3. Other friends.
4. Acquaintances.
5. Unwanted friends.
6. Wanted friends.
7. Friendship.
8. Allies.
9. Sympathies.
10. Us.
11. (Other)
1. Strong enemies.
2. People pc dislikes.
3. People who dislike pc.
4. ARC breaks.
5. Opposition groups.
6. Opposition force.
7. Them.
8. (Other)
1. Job or work.
2. Clubs.
3. Organizations.
4. Common purposes.
5. Social groups.
6. Activity with others.
7. Support of others.
8. Other groups.
9. Dues and financial support.
10. Contributions.
11. Benefits.
12. Codes and rules.
13. Membership.
14. (Other)
1. Local government.
2. Regional government.
3. National government.
4. Nationality.
5. Foreigners.
6. Politics.
7. Elections.
8. Government leadership.
9. Types of government.
10. Taxes.
11. Laws.
12. Courts.
13. National boundaries.
14. Government ownership.
15. Government workers.
16. Government control.
17. (Other)
1. Social conduct.
2. Codes.
3. Right and wrong.
4. Law enforcement.
5. Law breaking.
6. Criminal activities.
7. Criminal record.
8. Contributions.
9. Benefits.
10. Classes.
11. Public ownership.
12. Public servants.
13. (Other)
1. Pc’s race.
2. Other races.
3. Racial differences.
4. Racial similarities.
5. Color.
6. Racial land areas.
7. Unusual peoples.
8. (Other)
1. Work.
2. Social.
3. Recreation.
4. Other areas.
5. Responsibility for others.
6. Good leadership.
7. Bad leadership.
8. Control.
9. Followers.
10. (Other)
1. Auditing.
2. Co-auditing.
3. Group auditing.
4. Missions.
5. Field groups.
6. Central Orgs.
7. HCO.
8. Courses.
9. Dissemination.
10. L. Ron Hubbard.
11. Saint Hill.
12. (Other)
1. __________
2. __________
3. __________
4. __________
5. __________
6. __________
7. __________
8. __________
9. __________
10. __________
1. Communication between countries.
2. War.
3. Peace.
4. World government.
5. International trade.
6. Languages.
7. Tourists.
8. World business.
9. Treaties.
10. International law.
11. (Other)
1. Intelligent life on other planets.
2. Marcab Federation.
3. Galactic Federation.
4. Space travel.
5. Flying saucers.
6. Position of Earth to the universe.
7. (Other)
1. Radio and TV.
2. Newspapers.
3. Books.
4. Art.
5. Cinema.
6. Theater.
7. Entertainment.
8. (Other)
1. The role of mankind.
2. Survival of the species.
3. Overpopulation.
4. Underpopulation.
5. The new man.
6. (Other)
1. World dissemination.
2. Scientology publications.
3. Scientology One.
4. Psychotherapy.
5. World clearing.
6. Scientology future.
7. The role of Scientology.
8. Scientology success.
9. Scientology failure.
10. Scientology growth.
11. Mental healing methods.
12. The public image.
13. The future of mankind.
14. Healing.
15. Clearing.
16. Operating Thetans.
17. Scientology influence and control.
18. (Other)
1. __________
2. __________
3. __________
4. __________
5. __________
6. __________
7. __________
8. __________
9. __________
10. __________