GT Referral – Parent Form

Russellville School District - Gifted & Talented Office
Dana Sumter, GT Coordinator
2203 S. Knoxville, Russellville, AR  72802
Phone: 479-968-3106    
Email: dana.sumter@rsdk12.net
 
All information on this form will be kept strictly confidential and will be used only by GT program personnel and the appropriate referral/placement committee.
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Email *
Student Name *
Classroom Teacher
Current Grade *
School Building *
Parent Name *
Parent Phone Number *
I would like to refer my child for participation in the Russellville School District Gifted & Talented Program. Among the reasons for this referral are the following; *
A copy of your responses will be emailed to the address you provided.
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