Gifted/Talented Referral Form
Please fill out this form to nominate a student to be screened for the Gifted and Talented Program.


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Name of person completing the form: *
Requestor is a: *
Required
If the requestor is the parent/guardian, the requestor hereby grants the district permission to screen his/her child. *
FIRST NAME of student being referred: *
LAST NAME of student being referred: *
Grade Level of Student: *
Homeroom Teacher of Student: *
I believe this child has an extraordinarily high level of intellectual or academic ability and that his/her educational needs can best be met by Gifted/Talented serivces. I understand that the school district will make every effort to determine the best possible educational services based on the student's need. *
Required
I further understand that a bright student or high performer does not necessarily equate to "gifted". 

Gifted students may not make good grades especially in subject areas they do not like.

Gifted students may exhibit behavior problems or may not exhibit a desire to please the teacher.

Students with disabilities and English Language Learners who appear to be gifted should also be norminated.
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By typing my name below, I recognize that I am electronically signing this form. *
In order to complete the portfolio for the screening committee, completed parent and teacher surveys are required.  *
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