Visual and Performing Arts - Dance (input form)

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Please complete the following survey for those students who demonstrate advanced ability in the area of dance. Be as thorough as you can to give the committee a complete description of the student.
The committee also requires an audition, either live or video, preferably demonstrating a variety of dance techniques. If the student has been accepted into a special program or has won distinguished awards for dance, these can take the place of an audition.

Today's Date

YYYY

Student's Name *

Student's Grade Level *

Your Name *

School/Organization *

How do you know this student? *

Special Considerations

Please mark if applicable.

Environmental:

Transiency - at least 3 moves

Home with little enrichment or stimulation

Parental attitude demonstrating rejection or indifference

Language:

English as a second language

Lack of verbal intellectual stimulation due to limited language facility

Cultural:

Barriers to functioning meaningfully in dominant culture due to limited exposure

Standards conflict with dominant culture, involving peers, parents & community

Lower self-esteem due to self-comparison with dominant culture standards

Economic:

Residence in depressed economic area with high concentration of poverty

Low family income (free/reduced lunch)

Large family living at subsistence level

Inability to participate in varied experiences outside the home

Student with an Individual Learning Plan (IEP) or a 504 Plan:

Student has an IEP

Student has a 504 Plann

Underachieving Student:

Achievement gap between what the student should be able to do and performance

Other:

Medical issues impacting achievement

Other factors as described in formal recommendation

Checklists of Gifted Characteristics: For the behavioral checklist, please click on descriptors that are valid for this student.

Dance - Gifted Behavioral Checklist *

Uses body as an instrument of expression

Dances or moves to music frequently; encourages others to do so as well

Uses movement to recreate an emotion or environment

Able to think of many ways of solving movement problems

Displays grace and fluidity of movement

Successful in performing before an audience

Quickly learns choreographed movements

Can change direction, level and focus of movement

Masters basic dance skills quickly and easily

Improvises to music

Has awareness of line and the design of body in space

Appears to feel the rhythm of music

Enjoys observing different styles of dance

Communicates to others through his/her dance

Deals effectively with own center for gravity

Demonstrates original talent by choreographing movements for others

Required

Please describe the dance strengths that this student has demonstrated when compared with same-age dancers. Include an opportunity (or opportunities) provided in the classroom or other environment that have challenged and/or motivated this student. *

Has the student been involved with pursuits with dance in or out of school (dance solos, special programming for dancers, summer camps, etc)? *

Yes

I don't know

If the previous answer is "yes", please provide a list of these pursuits.

Please indicate your level of recommendation for this student: *

Highly recommend

Recommend

Recommend with reservations (please explain below)

Do not recommend (please explain below)

If you responded with "Recommend with reservations" or "do not recommend" to the previous question, please provide a brief summary of your reasoning.

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