A risk assessment instrument for identifying potential dropouts at the middle and high school levels and an accompanying explanation of the instrument are provided in this document. The instrument provides a checklist of 21 criteria; the more criteria the student meets, the greater his risk of dropping out. Criteria include age in comparison to grade; standarized test performance; retention history; subject failure; tardiness, truancy, and excessive absences history; suspension/expulsion history; delinquency; handicapping condition without employability development services; lack of pre-college or vocational education course sequence; inadequate projected units to graduate with class; non-participation in extracurricular activities; previous classification as a dropout; drug use; pregnancy/parenthood; living in household receiving Aid to Families with Dependent Children; living outside two-parent home situation; and having parents and/or siblings who did not graduate from high school. It is noted that the instrument has not been validated. (ABL)