Gifted Identification Referral Form

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Referrals are accepted throughout the school year. We try to accommodate testing requests quickly, but only the initial (first time) testing must be within a 90 day window after referral. All requests received in May will be honored in the following school year. Questions? Contact giftedservices@lakotaonline.com.

Email *

Please choose the appropriate box below: *

Second Opportunity Testing - (student has been tested by Lakota previously)

Initial Testing (student has not been tested by Lakota in 2nd or 5th grade previously)

Required

Student's last name *

Student's first name *

Student's School ID *

Students Date of Birth *

YYYY

Student Gender *

Male

Female

Prefer not to answer

Homeroom Teacher's Last Name *

Student's current Grade *

Student's School *

Parent/Guardian contact phone number (xxx) xxx-xxxx *

Parent/Guardian Email *

Testing referred by (choose one) *

Parent/Guardian

Teacher

Name of person referring testing *

Can results be shared via email? *

Yes

Reason for Testing *

Assessments will only take place when this form is signed by a parent or legal guardian, which grants permission for the Gifted Department to assess the student. Please enter the name of the parent/guardian granting the district permission to assess the student. We will schedule testing during the school day and test in the student's home building. *

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