Reagan Elementary School Parent Referral Survey

In order to make QUEST placement decisions concerning your child, we need your help in obtaining a complete profile of your child’s creative and productive thinking behaviors and characteristics. Please consider each of the behaviors listed below as they might apply to your child's interest, activities, and behaviors, and mark the appropriate response for your child. To help clarify items, we have included examples for each one. You should rate your child based on the general item, not the example. *For those items you circle Quite Often or Almost Always, please include a description of a specific time your child demonstrated the behavior. 

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Email *
Student's Name, Grade, Homeroom Teacher *

1. My child will spend more time and energy than his/her age mates on a topic of his/her interest. (For example: Jenna wants to be a fashion designer and spends her free time designing new fashions and using her dolls as fitting models.) 

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1. Specific example demonstrated by your child: 

2. My child is a “self-starter” who works well alone, needing few directions and little supervision. (For example: After watching a film about musical instruments, Derek began to make his own guitar from materials he found around the garage.) 

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2. Specific example demonstrated by your child: 

3. My child sets high personal goals and expects to see results from his/her work. (For example: Marissa insisted on building a robot from spare machine parts even though she knew nothing about engines or construction.) 

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3. Specific example demonstrated by your child: 

4. My child gets so involved with a project that he/she gives up other pleasures in order to work on it. (For example: Chris is writing a book about his town’s history and spends each night examining historical records and documents -- even when he knows he’s missing his favorite TV show.) 

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4. Specific example demonstrated by your child: 

5. My child continues to work on a project even when faced with temporary defeats and slow results. (For example: After building a model rocket, Allison continued to try to launch it, despite several failures and “crash landings.”) 

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5. Specific example demonstrated by your child: 

6. My child knows what is done well and what needs to be improved when working on a project. (For example: After building a scale model of a lunar city, Obi realized that there weren’t enough solar collectors to heat all the homes he had built.) 

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6. Specific example demonstrated by your child: 

7. My child is a “doer” who begins a project and shows finished products of his/her ideas. (For example: Kali began working on a puppet show four months ago and has since built a stage and puppets and a written script. Tomorrow she’s presenting it to the PTA.) 

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7. Specific example demonstrated by your child: 

8. My child suggests imaginative ways of doing things, even if the suggestions are sometimes impractical. (For example: If you really want to clean the refrigerator, why don’t we move it outside and I’ll hose it down -- that will defrost it, too.”) 

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8. Specific example demonstrated by your child: 

9. When my child tells about something that is very unusual, he/she expresses him/herself by elaborate gestures, pictures, or words. (For example: “The best way I can show you how a ballerina spins around is if I stand on my tiptoes and spin around.”) 

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9. Specific example demonstrated by your child: 

10. My child uses common materials in ways not typically expected. (For example: “I’ll bring a deck of cards when we go camping. If it rains, we can use them to start a fire, and if it’s dry, we can play “Go Fish.”) 

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10. Specific example demonstrated by your child: 

11. My child avoids typical ways of doing things, choosing instead to find new ways to approach a problem or topic. (For example: “I had trouble moving this box to the other side of the garage, so I used these four broom handles as rollers and just pushed it along.”) 

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11. Specific example demonstrated by your child: 

12. My child likes to “play with ideas,” often making up situations which probably will not occur. (For example: “I wonder what would happen if a scientist found a way to kill all insects and then went ahead and did it.”) 

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12. Specific example demonstrated by your child: 

13. My child often finds humor in situations or events that are not obviously funny to most children their age. (For example: Travis thoroughly enjoys play on words and puns. He creates his own that he shares at school but usually only the teacher “gets” them.) 

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13. Specific example demonstrated by your child: 

14. My child prefers working or playing alone rather than doing something “just to go along with the group.” (For example: Zachary works on his science experiments that he designs himself rather than goes with his friends to hang out at the mall on weekends.) 

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14. Specific example demonstrated by your child: 

15. My child tends to be a leader in group situations. (For example: Maria organized her neighborhood friends into a drama club. She had them write scripts, make props, and put on performances for neighborhood audiences.) 

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15. Specific example demonstrated by your child: 
A copy of your responses will be emailed to the address you provided.
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