Referral for Gifted Identification

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Ohio defines a student who is gifted as one who “performs or shows potential for performing at remarkably high levels of accomplishment when compared to others of their age, experience, or environment” (Ohio Revised Code 3324.01).

This referral form is used for recommendation for gifted identification. The review of available data and information about the student's learning characteristics, development, and performance will result in a decision about the type of assessment needed to determine eligibility for gifted identification.

Email *

First Name of Person Making Referral
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Last Name of Person Making Referral
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Email of Person Making Referral
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Relationship to Student (check one):
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Parent/Guardian

Teacher

Administrator

Gifted Intervention Specialist

School Counselor

Peer

Self-Referral

Other:

Required

First Name of Student
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Last Name of Student
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Student Date of Birth:
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Grade:
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Parent/Guardian Name:
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Address:
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Parent/Guardian Phone Number:
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Parent/Guardian Email Address:
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Area of Referral:
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Superior Cognitive Ability

Specific Academic Ability: Reading/Writing

Specific Academic Ability: Mathematics

Specific Academic Ability: Science

Specific Academic Ability: Social Studies

Creative Thinking

Visual or Performing Arts: Dance

Visual or Performing Arts: Drama

Visual or Performing Arts: Music

Visual or Performing Arts: Visual Arts

Required

What are some indicators that suggest that this student is gifted?
*

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