Primary Talent Pool Referral Form (Grades K-2 only)
For children in the primary program, the procedure for selecting a high potential learner for participation in the primary talent pool shall include use of a minimum of three (3) of the following recognized or acceptable assessment options to assess the degree of demonstrated gifted characteristics and behaviors and to determine level of need and most appropriate service interventions:

(a) A collection of evidence (e.g., primary portfolios) demonstrating student performance;
(b) Inventory checklists of behaviors specific to gifted categories;
(c) Diagnostic data;
(d) Continuous progress data;
(e) Anecdotal records;
(f) Available formal test data;
(g) Parent interview or questionnaire;
(h) Primary review committee recommendation;
(i) Petition system; and
(j) Other valid and reliable documentation.

(11) Exit from the primary program shall be based on criteria established by 703 KAR 4:040.
Student Name:
Your answer
Name of person completing this form:
Your answer
Relationship of person completing form to student
Please give specific reasons and examples of talent in this student:
Your answer
Please indicate evidence pieces that you could submit demonstrating this student's area(s) of advanced learning.
Your answer
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