Lockhart ISD Gifted and Talented Referral Form 2019 - 2020
Please complete the following questions to refer a student for a gifted and talented evaluation.
Email address *
Enter the formal registered first name of the student (no nicknames please). *
Your answer
Enter the formal registered last name of the student. *
Your answer
Lockhart Student ID *
For example: James Smith might be SMITHJAM002 If unknown, write "unknown"
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
Ethnicity *
Required
LISD Campus *
Student's Grade Level (2018-2019) *
Current elementary teacher or JH or HS advisor *
Your answer
Has this student been referred for testing previously *
If yes to above question, state when and where testing occurred
If tested in another district, please state where
Your answer
Testing Accommodations *
If the student is served by Special Education, 504, LPAC, or RtI and receives testing accommodations, please indicate the accommodations this student receives. If the student does not receive any testing accommodations through the committees listed, please enter the word, "None."
Your answer
First Language of the Student (if other than English)
Your answer
First and last name of parent/guardian contact *
Please enter only one parent contact name
Your answer
Parent/Guardian phone *
Format xxx-xxx-xxxx (This is the contact number the TAG Department will use, if needed)
Your answer
Parent/Guardian email address *
Your answer
Referral Type *
Required
Electronic Signature by LISD Employee
By signing below, I acknowledge and agree to the following: I am referring a student for Lockhart ISD Gifted and Talented services. I understand that consideration for participation will involve assessment of the learner's abilities and achievement. I will assist in gathering and providing data for this process. I also understand that Lockhart ISD must receive permission from a parent/guardian to go through the assessment process.
Your answer
Electronic Signature by Parent/Guardian
By signing below, I acknowledge and agree to the following: I am referring my child for Lockhart ISD Gifted and Talented services. I understand that consideration for participation will involve assessment of the learner's abilities and achievement, and I understand that my child must meet or exceed the criteria established under LISD policies and procedures to qualify for services.
Your answer
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