Gifted Referral Form

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All referrals for the gifted testing must be done using this electronic form. Phone calls to buildings will be referred to this form.

Madison provides two opportunities for gifted referral testing each year, one in the fall and one in the spring. The earlier this form is submitted, the better we can plan for those assessment times.

If your student will NOT be screened for gifted services with the testing scheduled below, please complete this form.

All students in grades 2nd-11th will take the NWEA MAP reading and math assessments three times a year.

Students in grades 3-5th will take the NWEA MAP science assessments

All students in grades 2 & 5 will take the Cognitive Abilities Test (CogAT, 2nd spring and 5th fall)

** Please note that gifted services begin in 3rd grade at Madison Local School District.

If you have any questions, please contact Brandi Clark Coordinator of Gifted Services at brandi.clark@madisonmohawks.org

Email *

Name of person who is making the referral *

How long have you known this student? *

Homeroom teachers name *

Students Name *

Students Grade *

Gifted identification being referred for *

Superior Cognitive Ability

Creative Thinking Ability

Specific Academic Ability * (if referring for this area please list which subject you feel the students demonstrates gifted ability)

Visual Performing Arts

In a few short words please describe why you feel this student demonstrates gifted ability. *

Send me a copy of my responses.

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