2018-19 Mason City Schools Gifted Identification Testing Sign-Up for Grades K-5
Student Last Name *
Your answer
Student First Name *
Your answer
Student ID Number *
Your answer
Student's Birthdate (mm/dd/yyyy) *
Your answer
Student's Homeroom Teacher's Name *
Your answer
Student's Homeroom Number *
Your answer
Student's 2018-19 Grade *
School of Attendance *
Does your student have an IEP or 504 Plan? *
If you answered "Yes" to the question above, please use the space below to describe the accommodations or modifications required for the test.
Your answer
Does your student attend the Extended Care program before school? *
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Relationship to Student *
Parent/Guardian Contact Phone Number *
Your answer
Parent/Guardian Contact e-mail address *
Your answer
Parent/Guardian Mailing Address *
Your answer
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