2025 Summer Gifted Screening Interest Form

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Email *

Record my email address with my response

Student's First Name *

Student's Middle Name *

Student's Last Name *

Student's Date of Birth *

YYYY

Address (Number and Street) *

City *

State *

Zip Code *

Parent's First Name *

Parent's Last Name *

Relationship to Student *

Parent's Phone Number 1 *

Parent's Phone Number 2

Email Address *

Student's Current School *

Entering Grade Level *

Program(s) Interested In *

Gifted

Scholastic Academy

Great Scholars Academy (grades 6-12)

Talented Music

Talented Theatre

Talented Visual Art

Other:

Required

How did you hear about Gifted and Talented Programs? *

EBR Website

Billboards

Flyers

Mailings

Friend or Family Memeber

Social Media

Other:

Required

Please initial to give permission for a representative from the EBR Gifted and Talented Office to contact you for more information. *

Send me a copy of my responses.

Submit

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