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Gifted Education Services Student Self-Report /Referral Form
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Student School of Attendance
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Name:  
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Date of Birth:  
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Address:  
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Parent Email:  
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Phone #
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Grade Level and School
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Suspected area of giftedness (please check all that apply) Academic Areas:
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Other Areas:  
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Gifted Education Services Student Self-Report /Referral Form
Gifted Education Services Student Self-Report /Referral Form
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Would you be able to provide any of the following related to your ability?
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Do you believe that your grades in school accurately reflect your ability? Why or why not?
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Do you believe that you have good study habits and organizational skills? Why or why not?
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Do you have any further observations or comments related to your performance, ability, interests, or perceptions about learning/school?
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