KVA Kindergarten Gifted and Talented Parent Checklist
This form is ONLY for KVA students.
*If your child is receiving face-to-face instruction on campus, do NOT use this form. Submit a paper checklist or use the link provided by your campus.

All screening will take place after students return for face to face instruction. You do not need to do anything further after submitting this form.

Due Date:  October 1, 2021

Katy Independent School District
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Email *
Student name: (last, first, mi) *
Student Birth Date *
MM
/
DD
/
YYYY
Gender( M or F) *
Ethnicity and Language Spoken at Home *
Child's elementary campus (Abbreviation only such as JRE) *
School Year *
Student ID *
Parent name/ telephone #/ work # *
Street address/ city/ TX/ zip code *
Current Grade *
Required
Parent/ Guardian Signature / Date *
Checking this box indicates that I give permission for the district to collect additional information about my child.  I also give permission for my child to be served in the GT Program if he/she is identified for placement.   *
Required
Select the number that best describes your child.
4 = My child demonstrates this trait most of the time.
3 = My child demonstrates this trait frequently.
2 = My child rarely demonstrates this trait.
1 = My child does not have this trait.
1. Questions friends and family on many different subjects. Asks how and why? *
2. Creates original stories and exhibits a vivid imagination in various ways. *
3. Sticks to a task once it is begun. *
4. Solves daily problems in many different ways. *
5. Has interests of older children and is mature above his/her age. *
6. Shows awareness of problems others may not recognize. *
7. Plans and/or organizes when playing and exhibits leadership skills. *
Please provide an example where indicated.
8. Shows active interest in the world around him/her. *
Example:
9. Enjoys discovering about numbers, patterns and puzzles. *
Example:
10. What other information about your child or your family would you like us to know?You may want to tell about an interest, talent or ability, or to share a special concern. *
A copy of your responses will be emailed to the address you provided.
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