Jonathan Alder Gifted Referral Form

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Please complete the form to begin the process for gifted identification screening and testing. This form is only intended for gifted identification. If you are interested in grade level or single subject acceleration, please contact Assistant Superintendent, Dr. Misty Swanger at Misty.Swanger@japioneers.org or 614.873.5621.

Email *

Student's Full Name *

Person Completing the Referral *

Parent Email

Please add an email address for permission forms to be sent electronically.

Person Completing the Referral *

Relationship to the student

Building *

Current Grade *

Date of Birth *

YYYY

Notes or information regarding this referral for the curriculum department.

Child is referred for possible identification in the following area(s) *

Select at least 1 and no more than 7

Superior Cognitive

Reading

Math

Science

Social Studies

Creative Thinking

Visual/Performing Arts

Subject OR Grade Level Acceleration (you must contact Dr. Swanger for this option)

Other:

Required

Superior Cognitive

Please check all that apply

Advanced vocabulary

Learns easily

Reads Intensively

Long Attention Span

Self-Motivated

Retains a quantity of information

Has a variety of interests

Works Independently

Alert and observant

Reflective- when asked a complex question or a given task, tends to take time to think before responding

Connective - makes connections with what is already known or tries to apply new information to other contexts

Abstract thinker = makes generalizations and draws conclusions that summarize complex information easily

Persistent in own interests - tried to follow through on self-initiated work

Independent thinker - follows own ideas, rather than others'

Other:

Specific Academic: Reading

Please check all that apply

Reads far above grade level

Self-taught reader

Reads intensively

Advanced comprehension

Advanced vocabulary

Writing is creative

Please specify other

Other:

Please list the last 4 books the student read that are above grade level.

Specific Academic: Math

Please check all that apply

Learns concepts easily

Is accurate in comprehension

Is anxious to learn more or go into depth

Shows an understanding far above grade level

Please specify other

Other:

Specific Academic: Science

Please check all that apply

Reads and talks about science topics often

Learns science concepts easily

Shows an interest in going deeper and farther into new science concepts

Other:

Specific Academic: Social Studies

Please check all that apply

Shows an interest in maps, globes, and other cultures

Reads and talks about social studies topics often

Shows an interest in news and news programs

Has a propensity to debate and can argue opposing sides of an issue

Other:

Creative Thinking

Please check all that apply

Is a divergent thinker

Has an unconventional response to conventional tasks

Elaborates on ideas

Displays original ideas

Fluent in idea generation and development

Experiments with ideas and hunches

Outstanding sense of humor

Brilliant thinker, but absentminded about details

Other:

Visual/Performing Arts

Please explain with specific examples that are available for a portfolio

Send me a copy of my responses.

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