PCS Gifted & Talented Referral Form

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For a student in grades four (4) through twelve (12), a local school district’s procedure for identifying and diagnosing gifted and talented behaviors and the level of services needed, shall include:

(a) A valid and reliable combination of measures to identify strengths, gifted behaviors and talents which indicate a need and eligibility for service options;

(b) At least three (3) of the following recognized or acceptable assessment options for identification and diagnosis:
- A collection of evidence from portfolios demonstrating student performance;
- Inventory checklists of behaviors specific to gifted categories;
- Continuous progress data;
- Anecdotal records;
- Peer nominations;
- Formal testing data specific to gifted categories;
- Parent interview or questionnaire;
- Primary review committee recommendation for those entering the fourth grade;
- Self-nomination or petition system;
- Student awards or critiques of performance or products specific to gifted categories; and
- Other valid and reliable documentation;

Email *

Student Name/Grade/School *

13) To qualify as a gifted and talented student in grades four (4) through twelve (12), the following criteria shall be met in one (1) of these gifted and talented categories. Please identify the area(s) that should be considered for this student. *

General intellectual ability shall be determined by a student score within the ninth stanine on a full-scale comprehensive test of intellectual ability. If a student scores low on formal group measures of intellectual ability, yet other documentation shows potential, the district shall administer an individual mental ability test.

Specific academic aptitude shall be determined by composite scores in the ninth stanine on one (1) or more subject test scores of an achievement test. If a student scores low on a formal group measure of academic strength, yet other documentation shows potential, the district shall administer another standardized normed achievement test.

Creativity shall be determined through the use of informal or formal assessment measures of a child’s capacity for originality of thought, fluency, elaboration and flexibility of thought.

Leadership or psychosocial abilities shall be determined by a variety of informal measures and the documentation of the willingness of a student to assume leadership roles in class, in a student organization and in a community activity. E

Visual and performing arts talent shall be determined through evidence of performance which may include auditions, letters of recommendations, or product or portfolio assessment by specialists or professional artists.

Required

Student Grade Level *

End of 3rd

4th

5th

6th

7th

8th

9th

10th

11th

12th

Required

Name of Person Completing the Form *

Relationship of Person Completing the Form *

Grade Level Teacher

Parent

Specials Teacher

School Counselor

Other

Required

Please give specific reasons for the nomination and examples of talent in this student: *

Please indicate evidence pieces that you could submit demonstrating this student's area(s) of advanced learning. *

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