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Grades 4-12: Special Considerations Form
Please complete this form for students whose eligibility for gifted services may be impeded by social, economic, and other academic factors.
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Student Name
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School
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Grade
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Your Name and Role (Ex: Sarah Carey, 7th grade English teacher)
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Your answer
Please check the characteristics that accurately describe the TYPICAL behavior of the student.
Has high mathematical ability.
Is alert and curious.
Is independent.
Show initiative and eagerness.
Is fluent in non-verbal communication.
Shows a lot of imagination in thinking.
Is flexible in his/her approach to a problem.
Learns quickly through experiences.
Retains and uses ideas and information well.
Shows a strong desire to learn in daily work.
Shows origniality and creativity in thinking.
Responds well to visual media.
Shows leadership in peer groups.
Behaves socially in a responsible manner.
Has interests in many different subjects.
Can show relationships between unrelated ideas.
Is resourceful, and has ability to solve problems.
Has entrepreneurial ability.
Is an imaginative storyteller.
Has a mautre sense of humor.
Low SES, EL, 2E, Environmental, Cultural
Check the boxes that apply to this student.
Environmental
Transiency- at least 3 moves
Home with little enrichment or stimulation
Parental attitude demonstrating rejection or indifference
Language
English as a second language
Lack of verbal intellectual stimulation due to limited language facility
Cultural
Residence in depressed economic area with high concentration of poverty
Low family income (free/reduced lunch)
Large family living at subsistence level
Inability to participate in varied experiences outside the home
Student with an Individual Learning Plan (IEP) or 504 Plan
Student has IEP
Student has 504 Plan
Underachieving Student
Medical issues impacting achievement
Other factors as described in formal recommendation
Please take this opportunity to provide any other pertinent information about this student that may help the GT Committee understand more about their disadvantage.
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