JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Gifted & Talented Referral Form
Fill out this form to refer a student for testing into the gifted and talented program at Lisa Academy.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Name
*
Your answer
Student campus
North Elementary (K-5)
North (6-12)
Chenal/West (K-6)
West (7-12)
Springdale (K-8)
Hybrid (K-12)
Virtual Student (K-12)
Rogers-Bentonville (K-8)
Clear selection
Student Grade
*
Choose
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
SIxth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
Your Name
*
Your answer
Your relationship to the student you are referring
*
Your answer
Male or Female
Female
Male
Non-binary or prefer not to say
Other:
Clear selection
Please explain why you believe this student needs services outside the regular classroom.
*
Your answer
If you have placement documents from another district that you believe might help in our identification process, please send them by sharing a Google Document to
jhartle@lisaacademy.org
, or by emailing scanned documents, pictures, or letters to Mrs. Hartle. You may also give a copy to the Gifted and Talented Coordinator at your school or to someone in the front office of any LISA Academy school. We will contact you to acknowledge receipt of prior placement or to begin testing, if it is needed. Our goal is to serve all students with a demonstrated need for the GT program. Thanks!
Your answer
Please date your referral with today's date.
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Lisa Academy.
Report Abuse
Forms
