Lockhart ISD Gifted and Talented Referral Form 2019 - 2020
Please complete the following questions to refer a student for a gifted and talented evaluation.
Enter the formal registered first name of the student (no nicknames please).
Enter the formal registered last name of the student.
Lockhart Student ID
For example: James Smith might be SMITHJAM002 If unknown, write "unknown"
Date of birth
American Indian/Alaska Native
Black or African American
Native Hawaiian or Pacific Islander
Alma Brewer Strawn Elementary
Clear Fork Elementary
Plum Creek Elementary
Lockhart Junior High School
Lockhart High School
Student's Grade Level (2018-2019)
Current elementary teacher or JH or HS advisor
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
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."
First Language of the Student (if other than English)
First and last name of parent/guardian contact
Please enter only one parent contact name
Format xxx-xxx-xxxx (This is the contact number the TAG Department will use, if needed)
Parent/Guardian email address
Other School Employee
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.
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.
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