Gifted Identification Referral Form

This referral form is ONLY for cognitive ability testing. For math and reading testing, Lakota uses the MAP assessment, which is given three times per year. Referrals are accepted throughout the school year. We try to accommodate testing requests quickly, but only the initial (first time) testing must be within a 90 day window after referral. All requests received in May will be honored in the following school year. Questions? Contact giftedservices@lakotaonline.com.

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Email *
Please choose the appropriate box below: *
Required
Student's last name *
Student's first name *
Student's School ID *
Students Date of Birth *
MM
/
DD
/
YYYY
Student Gender *
Homeroom Teacher's Last Name *
Student's current Grade (gifted services begin in 3rd grade) *
Student's School *
Parent/Guardian contact phone number (xxx) xxx-xxxx *
Parent/Guardian Email *
Testing referred by (choose one) *
Name of person referring testing *
Can results be shared via email? *
Reason for Testing *
Assessments will only take place when this form is signed by a parent or legal guardian, which grants permission for the Gifted Department to assess the student.  Please enter the name of the parent/guardian granting the district permission to assess the student. We will schedule testing during the school day and test in the student's home building. *
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