Parent Referral for Gifted & Talented
Parent Gifted Nomination Form
Student Name *
Your answer
Student D.O.B. *
Your answer
Student ID # *
Your answer
Parent Name *
Your answer
Phone # *
Your answer
Address *
Your answer
Student's Teacher *
Your answer
Student's Grade Level *
Your answer
Date *
MM
/
DD
/
YYYY
Please check the 10 items that best describe this child's traits or that most usually or often apply to this child. *
Required
Does your child make up stories and has unique ideas? If yes, please give an example:
Your answer
Does your child invent games, toys, and other devices? If yes, please give an example:
Your answer
Does your child use many different ways of solving problems? If so please give an example:
Your answer
Does your child have a wide range of interests? If yes, please give an example:
Your answer
Does your child have many unusual hobbies or interests? If yes, please give an example:
Your answer
Does your child have a long attention span for things that interest her/him? If yes, please give an example:
Your answer
Does your child see patterns and connections that others don't see, even among things that are apparently unrelated? If yes, please give an example:
Your answer
Please list any other special talents or skills this child may have, or other factors you feel are important in understanding this child's abilities.
Your answer
Current grade in ELA/Reading *
Your answer
Current grade in Math *
Your answer
Current grade in Science *
Your answer
Current grade in Social Studies *
Your answer
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