Referral Form: Gifted Identification
Use this form to refer a student, who is demonstrating high performance or potential in your class, for testing for possible gifted identification. Academic testing is offered on October 19, 2019, and on February 22, 2020. Visual & Performing Arts (VPA) Assessment is offered on February 22, 2020.

For October academic testing, submit this form no later than September 20, 2019.

For February Visual & Performing Arts Assessment, submit this form no later than December 13, 2019.

For February academic testing, submit this form no later than January 14, 2020.

At this time, students in grades K-8 are tested multiple times, using ODE recognized assessments, throughout the year in two academic areas for possible identification as gifted. It is not necessary to refer these students for additional testing unless there are special circumstances (please describe these circumstances below).

At this time, students in grades 2 and 4 are tested in the fall using the CogAT for possible gifted identification in the areas of Superior Cognitive Ability and Creative Thinking Ability. It is not necessary to refer these students for additional testing while they are in grade 2 or grade 4, unless there are special circumstances (please describe these circumstances below).

Identification in the areas of Visual & Performing Arts (art, music, dance, drama) is a two-step process. Once the referral is submitted a checklist will be sent to the arts instructor for completion. After the checklist has been scored, students meeting the ODE criteria set for each VPA area will be invited to attend a demonstration of their talent.

If you have any questions, please contact Diana Gearhart at gifted@apslearns.org or 330.761.3108.

Please complete ALL of the fields below before submitting the form.
Email address *
Referring Adult *
Who is referring this student for testing? Please write this person's name and their relationship to the student (teacher, parent, counselor, etc.)
Your answer
Student's Full Name: *
Your answer
Student's ID Number (if known)
Your answer
Student's Birthday *
month/month. day/day, year/year--Example: 06-15-2009
Your answer
Student's School *
Which APS school does this student currently attend?
Your answer
Student's Grade *
Please choose the student's current grade from the drop-down choices below.
Does this student have an active IEP or 504? *
The State of Ohio recognizes different areas of giftedness: superior cognitive ability (general problem-solving skills); specific academic ability (reading, math, science, social studies); creative thinking ability; and visual-performing arts ability (dance, drama, visual art, music). Please check the area(s) of Potential giftedness. *
Required
What observations of this student's ability/achievement have prompted this referral for possible gifted identification? Please be as specific as possible.Reason(s) for Referral *
Your answer
Special Circumstances
If this student is being referred for an area of giftedness for which they have already been tested this year, please explain why you are referring this student for additional testing.
Your answer
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