Referral Questionnaire 
This form serves as the official referral for a Central Heights Independent School student to be tested for GT Services. If completed by the parent or guardian, this form serves as your acknoledgement and approval for testing according to the Central Heights GT Plan. 
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Email *
Student’s Legal Last Name *
Student’s Legal First Name *
Full Name of the parent or guardian answer the observation questions. 
Relationship to the Student *
Required
Student’s Grade Level *
Required
Enter Student’s Date of Birth
MM
/
DD
/
YYYY
Student’s Home Campus *
Required
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