Advanced Academics (GT) - Parent/Community Member Referral

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form in its entirety. There is a lot of information requested but this is to ensure that we are thorough in our consideration of your student for our Advanced Academics program. Once this form is received, a permission letter for assessment will be sent home. We cannot proceed with the assessment process without signed consent. All forms and requests are sent to Dr. Kristi Thaemlitz, Somerville ISD's Director of Curriculum and Instruction. You can contact Dr. Thaemlitz at kthaemlitz@somervilleisd.org.

Email *

Student's Full Name *

Grade *

Homeroom Teacher (K-4 only, if 5th grade, or older, please select "Not Applicable") *

Birth Date *

YYYY

Bright Child vs. Gifted Learner

Below are some differences listed to help you distinguish between a bright child and a gifted learner (Janice Szabos, "Challenge"). The lists do not describe *all* the traits and attributes of gifted children, however, it is a good reference to assist in recognizing distinguishing characteristics.

When have you observed this characteristic? *

Seldom/Never

Occasionally

Frequently

Almost Always

Has self-stimulated curiosity; shows independence in trying to learn more about something.

Adapts readily to new situations; flexible in thought and action; not disturbed if the normal routine is changed.

Organizes and brings structure to things, people, and situations.

Uses unique and unusual ways to solve problems.

Displays a great deal of curiosity about many things, often going beyond conventional limits.

Possesses a large storehouse of information about a variety of topics beyond the usual interest of the age.

Reasons things out, thinks clearly and comprehends meanings, makes generalizations and draws conclusions that summarize complex information easily.

Expresses interest in understanding self and others.

Strives toward perfection, is self-critical, is not easily satisfied with own speed or products.

Seems to sense what others want and helps accomplish it.

Has unusually advanced vocabulary for age level, uses terms in a meaningful way.

Seldom/Never

Occasionally

Frequently

Almost Always

Has self-stimulated curiosity; shows independence in trying to learn more about something.

Adapts readily to new situations; flexible in thought and action; not disturbed if the normal routine is changed.

Organizes and brings structure to things, people, and situations.

Uses unique and unusual ways to solve problems.

Displays a great deal of curiosity about many things, often going beyond conventional limits.

Possesses a large storehouse of information about a variety of topics beyond the usual interest of the age.

Reasons things out, thinks clearly and comprehends meanings, makes generalizations and draws conclusions that summarize complex information easily.

Expresses interest in understanding self and others.

Strives toward perfection, is self-critical, is not easily satisfied with own speed or products.

Seems to sense what others want and helps accomplish it.

Has unusually advanced vocabulary for age level, uses terms in a meaningful way.

Areas and Examples of Behaviors

Please select "yes" or "no" for which area(s) may apply to your student. Please give specific examples of behaviors for which you selected "yes" to support this area of nomination.

General Intellectual Ability *

Processes new information quickly, uses advanced vocabulary, sees connections in concepts, focuses for long periods of time on special interests, or enjoys solving puzzles and problems. (If you selected "no", type NA) *

Specific Academic Ability *

Shows unusual/advanced ability in reading and/or math (please specify below). Thinks logically and symbolically about quantitative and spatial relationships, can articulate a thorough and detailed response, sees multiple pathways to solve problems, or thinks abstractly and shows insight into novel situations. (If you selected "no", type NA) *

Creative Ability *

Has a vivid imagination, unique ideas in problem solving situations, may be a risk-taker, adventurous, non-conforming, often asks "why" or sees the unusual. (If you selected "no", type NA) *

Leadership Ability *

Organizes and leads groups, carries responsibility well, tolerant and flexible with peers, possesses good self-confidence, or may be overbearing at times. (If you selected "no", type NA) *

Briefly describe your child's major interests, hobbies, and other creative endeavors. *

What are your main reasons for referring your student to the Advanced Academics Program? Share your insights about his/her talents, abilities, and learning needs. (Please note: every student is expected to be challenged according to his/her abilities. Therefore, a desire to have your child challenged is NOT a reason for an Advanced Academics referral.) *

Please include any other information which you believe is relevant and would assist us in getting to know your child's interests and abilities. (Ex: exceptional work samples, academic accolades, outside testing results, evidence of participation in outside educational programs.) These items may be sent to the school c/o Dr. Kristi Thaemlitz or digitally sent to kthaemlitz@somervilleisd.org. *

By selecting "I Agree" below you are declaring that you understand the following: I understand that tests of ability, aptitude, or achievement may be administered to my child as part of the identification process. By selecting "I Agree" I am granting permission for Somerville ISD to conduct any necessary assessments. Results of all tests will be shared with parents. *

I Agree

I Do Not Agree

Required

Clear form

Never submit passwords through Google Forms.

This form was created inside of Somerville I.S.D. Report Abuse

Forms