Life Events Checklist (Modified)

Event
(1) Place an “X” in the space to indicate you have experienced the event
(2) Indicate whether you viewed the event as a good or bad event
(3) Indicate how much effect the event has had on your life.
Only respond to those events which you have actually experienced during the past year.
1. Moving to a new home
2. New brother or sister
3. Changing to a new school
4. Serious illness or injury of family member
5. Increased number of arguments between parents
6. Mother or father lost job
7. Death of a family member
8. Parents separated
9. Death of a close friend
10. Increased absence of parents from the home
11. Brother or sister leaving home
12. Serious illness or injury of close friend
13. Parent getting into trouble with law / police
14. Parent getting a new job
15. Change in parents’ financial status
16. Trouble with brother or sister
17. Special recognition for good grades
18. Losing a job
19. Making the honor roll
20. Failing a grade
21. Increase in number of arguments with parents
22. Major personal illness or injury
23. Trouble with teacher
24. Failing to make an athletic team / sports team
25. Making failing grades on report card
26. Making an athletic team
27. Trouble with classmates
28. Getting recognition for athletic performance
Other events which have had an impact on your life. List and rate.
29. -‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–
30. -‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–
31. -‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–
32. -‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–‎–
 
This instrument can be found on pages 87-89 of “In Moving to a New Country: Children and Adolescent’s Adaptation”‚ available online at: http://scholar.lib.vt.edu/theses/available/etd-44915251972550/unrestricted/etd.pdf
 
Type of event: Good‚ Bad
Impact of effect of Event on your life: no‚ some‚ moderate‚ great
 

Johnson‚ J. H.‚ & McCutcheon (1980). Assessing life stress in older children and adolescents:Preliminary findings with the Life Events Checklist. In I. G. Sarason & C. D. Speilberger(Eds.)‚ Stress and Anxiety. Washington D.C.: Hemisphere.

Shenoy‚ Uma A. 1996. In Moving to a New Country: Children and Adolescent’s Adaptation. Virginia Polytechnic Institute. ma‎ster’s Thesis

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