Gifted Education Services Student Self-Report /Referral Form
Please complete this form and return it to the Gifted Education Teacher at your school. Your insight into your own strengths and interests is an important part of determining the services and programming for you. Your input will help us determine whether you would be served in the Gifted and Talented (GT) / Talent pool program. Should you qualify for an Advanced Learning Plan (ALP) through the GT program, your input will also be critical in developing and updating your annual ALP.
Name: *
Your answer
Date of Birth: *
MM
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DD
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YYYY
Address: *
Your answer
Parent Email: *
Your answer
Phone # *
Your answer
Grade Level and School *
Your answer
Suspected area of giftedness (please check all that apply) Academic Areas:
Other Areas:
Creative/Productive Thinking
Music
Psychomotor Ability (athletics)
Performing Arts
Visual Arts
Leadership Ability
Dance
Other Areas
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