Grades 4-12 Referral "Leadership"
Please note that referred students for Leadership must also have a letter of recommendation from the community, a self recommendation letter highlighting leadership in a student organization, and a letter of recommendation from a teacher who witnesses leadership in class. Students also can have awards, etc... to submit as pieces of evidence.
Student: *
Your answer
School: *
Grade: *
Date: *
Teacher Making Referral: *
Your answer
Does the student have:
Indicate your level of recommendation for this student (check one) *
Psycho-social or Leadership Ability refers to possessing either potential or demonstrated ability to perform at an exceptionally high level in social skills and interpersonal qualities. Examples would include: poise, effective oral and written expression, managerial ability, and the ability to vision or set goals and organize others to successfully reach those goals. Please describe the academic, intellectual, creative, and/or leadership strengths that this student has demonstrated in the classroom. *
Your answer
What things have been done in the classroom to challenge, motivate, or further develop these leadership strengths? *
Your answer
Leadership Characteristics Behavioral Checklist *
Rarely or Not Observed
Influences others to work toward a goal (desirable or undesirable)
Looked upon by others when a decision must be made
Tends to dominate peers or situations
Participates and often initiates various social activities
Transmits his/her enthusiasm for a task to others
Recognizes others' skills and abilities and finds a place for him/her in a group setting
May appear bossy at times
Interacts easily with both peers and adults
Sought out by other students for activities
Appears to have a deep sense of justice and fair play
Responsible, trustworthy, and carries responsibility well
Shows sensitivity to others
Directs instruction or activities when others are involved
May be frustrated by lack of organization or progress
Makes things happen
Often a captain of a team
Self confident with all others and comfortable about sharing strengths
Cooperative with others and easy to get along with
Communicates effectively; good verbal ability
Can easily adapt to new environments
Sociable and enjoys others' company
Excels in athletic activities; coordinates activities and games well
Flexible in thought and actions
Does this child have any special considerations that may mask his/her GT abilities? (Check all that apply)
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