SWISD GT Referral Form - Project Education

This form is designed to give parents and/or teachers an opportunity to nominate a student enrolled at Southwest ISD to be screened for the Gifted and Talented Program. Each campus along with district staff will collaborate to screen nominated students in order to determine if they should receive gifted and talented services at the school. Not all students who are screened will automatically qualify to receive gifted and talented services. If you would like to nominate your child for the gifted and talented program please complete this form. Referrals are accepted year-round with an annual testing window. Please contact the school if you have any further questions regarding G/T testing or services. Other information that is considered in the referral process includes: input from the campus educators, a teacher survey form and anecdotal, samples of student work, grades, achievement test data, and educational abilities test data. Additional Information about the G/T Program can be found here https://drive.google.com/file/d/1G0aP9t1IWwrjXyqNwt4cqJ0xL-5leFjv/view Please take a few moments to help us understand your child in his/her learning and interactions. This information will help the district GT Committee make a professional determination if he/she should receive GT services. Student ID is required to submit this form, please have it ready before submitting it. If you do not know your student's ID, please contact their campus to obtain it before proceeding.

General Information

Student ID (numbers only)

Student First Name

Student Last Name

Student Campus

Grade

Date of Birth: (MM/DD/YYYY)

Homeroom Teacher (K-5) Last Name Only (If known)

Your relation to the student

Name of person submitting this form:

Phone number of person submitting this form:

Email of person submitting this form:

Parent/Guardian Permission For Assessment And Participation

APPROVE: My typed name below represents my signature and confirms my permission for Southwest ISD to assess my child for advanced learning opportunities such as gifted services or acceleration and for my child to participate in any such services for which he or she is identified.

DENY: My typed name below represents my signature and confirms that I deny permission for Southwest ISD to be assessed for possible GT services. By completing this section, I am acknowledging my student will not be evaluated for GT and therefore will not be eligible for services.

Parent/Guardian Signature:

Date:

Previous GT Screening

Has the student previously qualified for a gifted program?

If the student previously qualified in a gifted program, please give as much of the following information as you know. Please attach any documentation you may have at the bottom of this form.

Previous Campus

School District:

City, State

Parent Inventory

Instructions: Please choose the frequency for each item that you feel best describes your child. Almost Always Sometimes Rarely Not Observed

Asks a lot of questions

Tells detailed stories

Has a large vocabulary

Engages in world play/puns

Has unusual ideas/makes unpredictable connections

Discusses his/her interests in detail

Notices patterns

Shows strong feelings and opinions

Prefers to talk with adults/older children rather than peers

Is concerned with social issues/”grown-up problems”

Initiates projects at home

Is a good guesser rather than a memorizer

Is keenly observant

Enjoys solving riddles, puzzles

May be able to solve problems without being able to explain how

Displays persistence when faced with a challenge

May not be motivated by grades

Preferred language for testing (if available):

Does your student receive testing accommodations according to an IEP or 504 plan? This information is NOT used for identification purposes. It is ONLY used to determine if a particular testing environment is needed.

Please share about a time when your child surprised you with his/her ability, depth of understanding, and/or knowledge on a topic.

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