Nomination Form for Gifted Services Screening (for 3rd, 4th, 5th, & 7th graders)
Complete this form if you believe your student is performing well above grade level or demonstrating exceptional strengths or talents and believe the student’s performance and achievement should be reviewed to determine eligibility for gifted or advanced education services.

Determination of services will be completed in late spring. The District Gifted Services Team will consult available student academic data to determine need for gifted services. Students in grades 3-6 who are eligible for services will receive advanced instruction during the daily Science and Social Studies content block.  Beginning in 6th grade, identified students may receive advanced math services. Students at the junior high will receive services in either Advanced English Language Arts and Social Studies, Advanced Math, and/or Advanced Science. Parents will be contacted by the end of the current school year regarding placement for the next school year.
Sincerely,
Leslie Loboda
W68 Gifted Services Coordinator

Student's first name *
Student's last name *
Student's current grade level *
Student's current school *
Name of person completing this nomination form *
Relation to the student *
Distinguishing Characteristics:
This student imagines things to be different than the way they actually are. Wonders “What if?” or “What would happen if?” *
This student has self-stimulated curiosity; shows independence in trying to learn more about something. *
This student chooses difficult problems over simple ones. *
This student uses unique and unusual ways to solve problems. *
This student adapts readily to new situations; is flexible in thought and action; is not disturbed if the normal routine is changed. *
This student displays a great deal of curiosity about many things, often going beyond known or conventional limits. *
This student possesses a large storehouse of information about a variety of topics beyond the usual interests of age peers. *
This student reasons things out, thinks clearly, and comprehends meaning. *
This student expresses interest in understanding self and others. *
This student strives toward perfection, is self-critical, and is not easily satisfied with own speed or products. *
This student makes generalizations and draws conclusions that summarize complex information easily. *
This student can perform more difficult mental tasks than age peers. *
This student is able to work through frustration and maintain focus. *
This student sees flaws in things, including their own work, and can suggest better ways to do the job or to reach an objective. *
This student meaningfully uses advanced vocabulary for age level.
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Please list any other relevant information that would assist the Gifted Placement Team.
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