Gifted and Talented Teacher Referral Form

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Teachers Grades K-12 Fill out student information.

(To be used when screening students for placement in grades K-12)

In referring a child for SISD's gifted and talented program, teachers and parents are asked to complete a checklist of behaviors. This checklist allows you to provide input on this student's behaviors during your class time. Please complete the form. Should you have any questions please contact the Director of Special Programs.

Instructions: Please use the numbers below.

0 = Not observed 1 = Rarely 2 = Sometimes 3 = Often 4 = Always

Email *

Student First and Last Name *

Grade Level *

Teacher's First and Last Name *

Learning Characteristics

Wants to know why and how.

0= Not Observed

1= Rarely

2= Sometimes

3= Often

4= Always

Learning Characteristics

Knows more words than children his/her age.

0= Not Observed

1= Rarely

2= Sometimes

3= Often

4= Always

Learning Characteristics

Asks unusual questions to find out more information.

0= Not Observed

1= Rarely

2= Sometimes

3= Often

4= Always

Learning Characteristics

Learns new things quickly.

0= Not Observed

1= Rarely

2= Sometimes

3= Often

4= Always

Learning Characteristics

Wants to know how things work.

0= Not Observed

1= Rarely

2= Sometimes

3= Often

4= Always

Learning Characteristics

Wide range of interest, or an intense interest in one area.

0= Not Observed

1= Rarely

2= Sometimes

3= Often

4= Always

Learning Characteristics

Makes connections between past and present experiences.

0= Not Observed

1= Rarely

2= Sometimes

3= Often

4= Always

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