Gifted Education Teacher Observation /Referral Form
Please complete this form and return it to the Gifted Education Teacher in your building.

Classroom teachers are critical in providing qualitative and quantitative data about a student's performance within the classroom. As the curriculum experts, teachers can provide a body of evidence of students working above their same-age peers. Evidence of exceptionality is above the 95th percentile while high abilities are below this level. An example of this might be a sixth-grade student who has already demonstrated masterly of seventh and eighth-grade math standards and has successfully completed all the geometry modules from an online math program. Advanced classroom performance must be measured through examples of above grade-level work. Earning an "A" in a class does not necessarily indicate exceptional performance. Grades lack standardization and are influenced significantly by students' motivation, classroom behavior, personal appearance, and study habits.

Student's Name: *
Your answer
Date of Referral: *
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DD
/
YYYY
Teacher: *
Your answer
Grade Level and School *
Your answer
Please check the statement below that best describes this student, as relates to his or her ability (NOT academic performance):
Suspected area of giftedness (please check all that apply) Academic Areas:
Other Areas:
Creative/Productive Thinking
Music
Psychomotor Ability (athletics)
Performing Arts
Visual Arts
Leadership Ability
Dance
Other Areas
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