Gifted and Talented Referral Form
adapted from the Renzuilli-Hartman Scale
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Teacher Name *
Student Name
School *
Grade *
How long have you known this child? *
Please check the subject area for which you are referring this student. *
You may check more than one.
Obligatoire
Please provide a brief description as to why you feel that this student requires gifted programming to help meet his/her needs.   *
Include any relevant test scores and/or observations.
Scales for Rating the Behavioral Characteristics of Superior Students (Adapted from Renzulli/Smith/White/Callahan/Hartman)
Student Behavior
Never
Seldom
Sometimes
Frequently
Displays a great deal of curiosity about many things; is consistently asking questions about anything and everything.
Generates a large number of ideas or solutions to problems and questions; often offers unusual, unique, clever responses
Nonconforming; accepts disorder, is not interested in details, is individualistic; does not fear being different.
Is a high risk taker; is adventurous and speculative. 
Becomes absorbed and truly involved in certain topics or problems; is persistent in seeking task completion. (It is sometimes difficult to get him to move on to another topic.) 
Strives toward perfection; is self critical; is not easily satisfied with his own speed or products.
Needs little external motivation to follow through on work that initially excites him.  Prefers to work independently; requires little direction from teachers.
Often is self assertive (sometimes even aggressive); stubborn in his/her beliefs.
Likes to organize and bring structure to things, people, and situations.
Explains things precisely and clearly. 
Uses descriptive words to add color, emotion and beauty.
Expresses thoughts and needs clearly and concisely.
Determines what information or resources are necessary for accomplishing a task.
Grasps the relationship of individual steps to the whole process.
Organizes his or her work well. 
Recognizes the various alternative methods for accomplishing a goal.
Can provide details that contribute to the development of a plan or procedure.
Carries responsibility well; can be counted on to do what he/she has promised and usually does it well.
Is self confident with children his/her own age as well as adults; seems comfortable when asked to show work to the class.
Is cooperative with teacher and classmates; tends to avoid bickering and is generally easy to get along with.
Adapts readily to new situations; is flexible in thought and action and does not seem disturbed when normal routine is changed.
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Please complete the checklist only for the area(s) where the student is being referred.
General Intellectual Ability
Never
Seldom
Sometimes
Frequently
Learns rapidly and easily
Retains what he/she has heard or read without much rote drill.
Able to do general academic work one to two years above class.
Has a variety of interests or may be intensely interested in a single area of study.
Seems to know many things that have not been taught.
Abstract thinker, recognizes relationships, takes pleasure in intellectual activity.
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Please complete the checklist only for the area(s) where the student is being referred.
Language Arts
Never
Seldom
Sometimes
Frequently
Reads a great deal
Has a large and/or rich vocabulary
Can express feelings of the characters to make them seem real.
Writes more than other students and appears to enjoy the process of composition.
Can introduce, develop, and conclude a story interestingly.
Enjoys composing poems, original stories, plays, journaling.
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Please complete the checklist only for the area(s) where the student is being referred.
Social Studies
Never 
Seldom
Sometimes
Frequently
Sensitive to social issues, concerned with moral and ethical questions.
Has a lot of up to date information on current events.
Reads or watches television programs dealing with global awareness.
Shows interest in learning a foreign language.
High interest level in global issues of environment, endangered species, etc.
Enjoys learning about the past, present, and future.
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Please complete the checklist only for the area(s) where the student is being referred.
Math
Never
Seldom
Sometimes
Frequently
Reasons effectively, likes logic problems and puzzles.
Grasps the abstract nature of mathematics easily.
Grasps concepts of spatial relationships. 
Enjoys trying to solve difficult problems. 
Likes to solve problems through discovery. 
Intuitive; has the ability to do deductive and
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Please complete the checklist only for the area(s) where the student is being referred.
Science
Never
Seldom
Sometimes
Frequently
Interested in science books and science programs on TV
Has science related hobbies, collections, likes gadgets.
Learns science concepts quickly. 
Curious about natural relationships and wants to understand how things work.
Comes up with good questions or ideas for experiments.
Persistent, sticks with investigations in spite of difficulties.
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Ce formulaire a été créé dans Allendale Public Schools.