CHARIS Program Parent/Community Member Referral Form
Arkansas Arts Academy 
Lainie Adams - GT Coordinator
2005 S. 12th Street
Rogers, AR  72758
Email:  ladams@artsk12.org

All information on this form will be kept confidential and will be used only the the GT program personnel and the appropriate referral/placement committee.

Please complete one form for each student you are referring for the GT Identification process.
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Email *
First & Last Name of Person Completing This Form *
Your Relationship to the Student *
Referral Date (Today's Date) *
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Student's Name - First & Last (Nickname) *
Students Date of Birth
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Student's Current Grade *
Homeroom Teacher's Name
Parent/Guardian Name(s) *
Student's Home Address
Parent/Guardian Phone Number(s)
Student Characteristics
Gifted & talented students are defined by Arkansas standards as those students of high potential or ability whose learning characteristics and education needs require qualitatively differentiated educational experiences and/or services. Students who possess these traits or have the potential for the development of these gifts and talents exhibit 1) above average intellectual ability, 2) task commitment and/or motivation, AND 3) creative ability.
I believe that this student exhibits the following characteristics: *
Required
I would like to refer this student for consideration for the CHARIS Gifted & Talented Program at Arkansas Arts Academy.  Reasons for this referral are as follows: *
Please list any supporting comments and/or additional information below.
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