Gifted Learner Parent and/or Teacher Referral
Please rank the child in areas you feel describe your child. You can provide additional information at the end of each of the five areas of Gifted/Talented:

~ General Intellectual Ability
~ Specific Academic
~ Creativity
~ Leadership
~ Visual/Performing Arts

IMPORTANT: You do NOT need to rank all areas if you are only referring your child for one. For example, if you are referring your child for math, you don't need to fill out the leadership, creativity, etc. portions of the form.

Sources:
~ U-STARS~PLUS - Coleman, Shah-Coltrane and Harrison: Council for Exceptional Children (2010)
~ Music Identification Handbook for Educators, Coordinators, and Administrators in Wisconsin Public Schools: WMEA and WI DPI (2009)
~ National Association for Gifted Children's Checklist of Characteristics Areas of Giftedness (CCAG)

Please see the Franklin Teaching and Learning website for additional information.

Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Grade *
Your answer
School *
Your answer
Parent First Name *
Your answer
Parent Last Name *
Your answer
Parent Email *
Your answer
Parent Contact Numbers *
Your answer
Teacher Name (First & Last) *
Your answer
Teacher Email *
Your answer
Person Completing Form (First & Last Name) *
Your answer
Person Completing Form (Email Address) *
Your answer
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