Student Nomination Form-4,6,7 and 9th Grades
Gifted and Talented Education Program (GATE)
CHARACTERISTICS OF GIFTED STUDENTS
This nomination form is provided to parents/guardians of students in grades 4, 6, 7, and 9 to submit their child’s name for possible placement in the DJUSD Gifted and Talented Education Program. If you feel many of the characteristics listed below describe your child, please fill in this form as completely as possible. (RETURN TO THE CUSTOMER SERVICE DESK, 526 B STREET, DAVIS, CA 95616, OR BRING TO TEST SESSION.)
Name of Child________________________________Gender_____Age_____Birthdate________________
Home Address___________________________________City_____________Zip_______________________
Parent/Guardian_______________Phone(home)_________work or cell)_______
Email______________________________(Will not be shared.)
Language spoken in home___________________Is child bi-lingual?__________
Racial/Ethnic Category (Check one):
__American Indian/Alaskan Native __Asian (Specify:_______) __Pacific Islander __Filipino __Hispanic __Black, not of Hispanic origin __White, not of Hispanic origin
School of Attendance_______________________Circle Grade: 4 6 7 9 Teacher______________________
School of Residence _____________________
Please circle the level to which each characteristic applies to your child:
U = USUALLY S=SOMETIMES R=RARELY
|
U |
S |
R |
Good problem solving abilities |
U |
S |
R |
Perfectionist |
|
U |
S |
R |
Rapid learning ability |
U |
S |
R |
Feelings hurt easily |
|
U |
S |
R |
Extensive vocabulary |
U |
S |
R |
Sensitive to other’s feelings |
|
U |
S |
R |
Excellent memory |
U |
S |
R |
Intense reactions to frustration |
|
U |
S |
R |
Long attention span |
U |
S |
R |
Questions authority |
|
U |
S |
R |
Unusual curiosity |
U |
S |
R |
Concern with morality and justice |
|
U |
S |
R |
Keen powers of observation |
U |
S |
R |
High level of creativity |
|
U |
S |
R |
Intense interest in books |
U |
S |
R |
Vivid imagination |
|
U |
S |
R |
Excellent sense of humor |
U |
S |
R |
High degree of energy |
|
U |
S |
R |
Unusual insightfulness |
U |
S |
R |
Wide range of interests |
|
U |
S |
R |
Enjoys playing with older children |
U |
S |
R |
Perseverance in areas of interest |
|
U |
S |
R |
Judgment seems mature for age |
U |
S |
R |
Interested in puzzles or mazes |
If child was GATE identified in another District: My child was GATE identified in______________________District in______________year.
(Please provide documentation or contact information)
Briefly describe why your child should be considered for GATE:
Indicate any special services or any health conditions which impact your child (e.g. RSP, asthma, etc.):
Parent Permission: I understand that my child will be tested for the Gifted and Talented Education program, and that if she/he qualifies, she/he will be identified as "GATE". As a result, I am entitled to apply to have my child placed in GATE self-contained classes. I further understand that I, the parent/guardian, may withdraw my student from the GATE program by mailing a letter to the GATE Office requesting she/he be disenrolled.
Parent/Guardian Signature__________________ Date_______
