Highly Capable Referral Form for Grades 9-11 High School Students

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Please take a moment to complete and submit this Referral form. The deadline to submit this form is Dec. 20, 2024. If you have questions, please reach out to the Student Success Coordinator at info@rootedschoolvancouver.org.

Email *

Student's First Name

Student's Last Name

Student's Current Grade Level

9th grade

10th grade

11th grade

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Name of the Person Making the Referral

What Role Do You Serve in the Student's Life?

I am referring myself as student

Parent / Guardian

Educator

Instructional Assistant

SpEd Educator

School Leader

Community member

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Reasons for the Referral (Specific Examples of the Student's Exceptional Abilities or Potential)

Which Learning Characteristics Listed Below Does the Student Possess?

Capacity to show depth and complexity of understanding outside their age range development

Transfer learning to create call-to-actions that positively impact others

Manage increasing levels of abstraction and communicate those levels to others

Connect ideas and concepts that are not easily seen by their chronological peers

Ability to learn quickly in their area(s) of intellectual strength

Capacity for intense concentration and/or focus; or capacity of keen intuition or empathy

Do You Believe that the Student You Are Referring Consistently Demonstrates 4 or More of These Characteristics?

Yes

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By Typing Your Name, You Affirm that You Have Responded to the Questions to the Best of Your Knowledge.

Today's Date (MM/DD/YYYY)

YYYY

Send me a copy of my responses.

Submit

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This form was created inside of Rooted School.