LISD Elementary/Intermediate GT Referral             (Grades 1-6)
It is the policy of Lindale Independent School District not to discriminate on the basis of race, color, national origin, sex or handicap in any programs, services or activities as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended. For information about your rights or grievance procedures, contact Jamie Holder, Deputy Superintendent, 505 Pierce Street, Lindale, Texas 75771
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First Name *
Student's Last Name *
Check one *
Student ID # *
Student lunch # or library # (if you do not have this, you can ask the homeroom teacher or front office)
Student's Campus *
Student's Grade Level *
Has this student been tested for the GT program in LISD before? *
If so, in which grade was this student tested?
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Student's Homeroom Teacher *
Parent/Guardian Names *
Student's Mailing Address *
Street Address or P.O.Box
Student's Mailing Address *
City, State, Zip Code
Student's Home Phone
Cell Phone Number
Parent/Guardian E-Mail
Student's Birth Date *
MM
/
DD
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YYYY
Name of Person Referring Student *
Relationship to Student *
If you are the parent/guardian to this student, please type your name below to give the district permission to test your student for the Gifted and Talented Program. If you are not the parent/guardian, please move to the next question.
Academic Areas You Feel Student Exhibits Giftedness *
Required
Submit
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