Gifted Referral Form

Lakeside School District

Gifted/Talented Program

Referral Form


I WISH TO REFER THE FOLLOWING STUDENT TO BE CONSIDERED FOR THE GIFTED /TALENTED PROGRAM.

STUDENT’S NAME___________________________________ Grade________ Date__________

Person making recommendation___________________________________________________

Please check one: _____ Parent _____ Teacher _____Student  

_____ Other School Personnel _____ Community Member


I make this nomination _____ without reservation _____ with reservation

Teachers only - Attach a copy of the child’s latest Benchmark and/or other standardized test scores.  You may also include STAR reading levels, samples of writing, etc.

Please explain here why you believe this student should be considered for the Gifted & Talented program.  Please include multiple reasons and be specific.  (Do not list student’s grades or excellent behavior for a reason for referral)

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Return this form to : Jennifer Armstrong, GT Coordinator

(You may place them in her mailbox on the elementary campus)
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