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Mathematics
Person responsible for data collection lora.jones@corbin.kyschools.us
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This referral form is to be completed by the students current classroom teacher. Please carefully consider behaviors observed during class. Information included may be considered as one element of the identification process for Mathematics.
Name of student and current grade
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Your answer
Date of referral
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Your answer
Indicate how often you observe the student demonstrate the following behaviors:
Is eager to solve challenging math problems, puzzles, games, and logic problems
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Never
1
2
3
4
5
Always
Focuses intensely on math applications
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Never
1
2
3
4
5
Always
Displays a strong sense of number sense, easily and accurately
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Never
1
2
3
4
5
Always
Intuitive- has the ability to do deductive and inductive reasoning
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Never
1
2
3
4
5
Always
Applies math skills in other activities and subjects without prompting
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Never
1
2
3
4
5
Always
Solves math problems abstractly without the need for manipulatives or concrete materials
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Never
1
2
3
4
5
Always
Please indicate at least three of the following evidences that this student is exceptional in math
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Assessment data ( MAP or State testing)
Acquired in class grades
Observation of the student's abilities in class
Parent comments
Other:
Required
Please indicate if you feel this student is exceptional in Mathematics
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Yes
No
As a teacher, I would rank this student in the 96% or above , among other students in mathematics ability?
Yes
No
List any awards or recognitions received related to this area of identification.
Your answer
Thank you for completing this referral. Your expert opinion is of great value.
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