PEAK Parent/Guardian Referral Form
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School Name *
Student Name *
Teacher Name *
Date *
Parent/Guardian Name(s)
 *
Email(s) *

For each characteristic, read the descriptors and mark the box that describes your child. If you mark “usually,” provide an example or examples for how your child demonstrates the characteristic(s).

Advanced Language
- Uses advanced vocabulary.

- Uses figurative language (simile, metaphor, analogy) to explain things.

- Re-words his/her language for younger siblings.

Language Learners:

- Uses advanced vocabulary in home language.

- Good at translating for others.

- Learning 2nd (or 3rd/4th) language quickly. 

 *
Example/s (if “usually” is marked):

Sensitivity

- Very concerned about human rights/environmental issues.

- Demonstrates a strong sense of justice.

- Empathetic.

- Sets high expectations for themself and others.

- May struggle with perfectionism.

- May develop friendships with younger children to serve as a mentor.

 *
Example/s (if “usually” is marked):
Perspective

- Seeks to understand others’ points of view.

- Discusses/argues from more than one point of view.

- Connects new information to past experiences.

- Makes predictions based on past experiences.

 *
Example/s (if “usually” is marked):

Motivation

- Shows strong desire to learn.

- Extremely curious, asks endless questions, has a strong desire to know more.

- Learns everything they can about areas of interest.

- Pursues issues not typical for kids their age.

- May annoy others with obsession with a topic.

 *
Example/s (if “usually” is marked):

Analytical Thinking

- Approaches solutions and analyzes information in a logical manner.

- Can break a big picture idea into smaller bites.

- Solves difficult problems.

- Figures out complex, abstract relationships and patterns.

- May appear disorganized but enjoys organizing and planning in unique ways.

- Overanalyzes, preventing them from completing the task. 

 *
Example/s (if “usually” is marked):

Sense of Humor

- Intentionally incorporates humor.

- Demonstrates wit more than being just funny. 

- Appreciates adult humor.

- Produces original jokes and puns. 

- Knows how to properly use sarcasm to get a point across.

 *
Example/s (if “usually” is marked):

Accelerated Learning

- Learns new concepts quickly.

- Learned to read and/or do basic math before entering Kindergarten.

- Reading, writing, and/or math skills are well above grade level.

- Exhibits “multipotentiality” (desire to do everything and could be good at all of those things).

Language Learners:

- Learning 2nd (or 3rd/4th) language quickly.

*
Example/s (if “usually” is marked):
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