GT Referral Form

Parent/Guardian Permission For Assessment And Participation

Previous GT Screening (Optional)

Parent Scales

Directions: These scales are designed to obtain estimates of a student's characteristics in the area of learning, motivation, creativity, and leadership. The items are derived from the research literature dealing with characteristics of gifted and creative persons. It should be pointed out that a considerable amount of individual differences can be found within this population; therefore, the profiles are likely to vary a great deal. Each item in the scales should be considered separately and should reflect the degree to which you have observed the presence or absence of each characteristic. Since the four dimensions of the instrument represent relatively different sets of behaviors, the scores obtained from the separate scales should not be summed to yield a total overall score. Please read the statements carefully and choose the appropriate place according to the following scale of values: 1. If you have seldom or never observed this characteristic 2. If you have observed this characteristic occasionally 3. If you have observed this characteristic to a considerable degree 4. If you have observed this characteristic almost all of the time

Learning Characteristics

Has unusually advanced vocabulary for age or grade level; uses terms in a meaningful way; has verbal behavior characterized by "richness" of expression, elaboration, and fluency
Select 1 - Rarely 2 3 4 - Most of the time
Possesses a large storehouse of information about a variety of topics
Select 1 - Rarely 2 3 4 - Most of the time
Has quick mastery and recall of factual information
Select 1 - Rarely 2 3 4 - Most of the time
Has rapid insight into cause - effect relationships; tries to discover the how and why of things; asks many provocative questions; wants to know what makes things "tick"
Select 1 - Rarely 2 3 4 - Most of the time
Has a ready grasp of underlying principles and can quickly make valid generalizations about events, people, or things; looks for similarities and differences in events, people and things
Select 1 - Rarely 2 3 4 - Most of the time
Is a keen and alert observer; usually "sees more" or "gets more" out of a story, film, etc. than others
Select 1 - Rarely 2 3 4 - Most of the time
Reads a great deal on his own; usually prefers adult level books; does not avoid difficult material; may show a preference of biography, encyclopedias, and atlases
Select 1 - Rarely 2 3 4 - Most of the time
Tries to understand complicated material by separating it into its respective parts; reasons things out for himself; sees logical and common sense answers
Select 1 - Rarely 2 3 4 - Most of the time

Motivational Characteristics

Becomes absorbed and truly involved in certain topics or problems; is persistent in seeking task completion
Select 1 - Rarely 2 3 4 - Most of the time
Is easily bored with routine tasks
Select 1 - Rarely 2 3 4 - Most of the time
Needs little external motivation to follow through in work that initially excites him
Select 1 - Rarely 2 3 4 - Most of the time
Strives toward perfection; is self-critical; is not easily satisfied with his own speed or products
Select 1 - Rarely 2 3 4 - Most of the time
Prefers to work independently; requires little direction from teachers
Select 1 - Rarely 2 3 4 - Most of the time
Is interested in many "adult" problems such as religion, politics, sex, race-more than usual for age level
Select 1 - Rarely 2 3 4 - Most of the time
Often is self assertive; stubborn in his beliefs
Select 1 - Rarely 2 3 4 - Most of the time
Likes to organize and bring structure to things, people, and situations
Select 1 - Rarely 2 3 4 - Most of the time
Is quite concerned with right and wrong, good and bad; often evaluates and passes judgement on events, people, and things
Select 1 - Rarely 2 3 4 - Most of the time

Creativity Characteristics

Displays a great deal of curiosity about many things; asking questions about anything and everything
Select 1 - Rarely 2 3 4 - Most of the time
Generates a large number of ideas or solutions to problems and questions; often offers unusual, unique, clever responses
Select 1 - Rarely 2 3 4 - Most of the time
Is uninhibited in expressions of opinion; is sometimes radical and spirited in disagreement; is tenacious
Select 1 - Rarely 2 3 4 - Most of the time
Display a good deal of intellectual playfulness; fantasizes; imagines;manipulates ideas; is often concerned with adapting, improving, and modifying institutions, objects, and systems
Select 1 - Rarely 2 3 4 - Most of the time
Displays a keen sense of humor in situations that may not appear to be humorous to others
Select 1 - Rarely 2 3 4 - Most of the time
Is unusually aware of his impulses and more open to the irrational in himself; shows emotional sensitivity
Select 1 - Rarely 2 3 4 - Most of the time
Is sensitive to beauty; attend to aesthetic characteristics of things
Select 1 - Rarely 2 3 4 - Most of the time
Is nonconforming; accepts disorder; is not interested in details; is individualistic; does not fear being different
Select 1 - Rarely 2 3 4 - Most of the time
Criticizes constructively; is unwilling to accept authoritarian pronouncements without critical examination
Select 1 - Rarely 2 3 4 - Most of the time

Leadership Characteristics

Carries responsibility well; can be counted on to do what he has promised and usually does it well
Select 1 - Rarely 2 3 4 - Most of the time
Is self-confident with children his own age as well as adults; seems comfortable when asked to show his work to the class
Select 1 - Rarely 2 3 4 - Most of the time
Seems to be well-liked by his classmates
Select 1 - Rarely 2 3 4 - Most of the time
Is cooperative with teacher and classmates; tends to avoid bickering
Select 1 - Rarely 2 3 4 - Most of the time
Can express himself well; has good verbal facility and is usually well understood
Select 1 - Rarely 2 3 4 - Most of the time
Adapts readily to new situations; is flexible in thought and action and does not seem disturbed when the normal routine is changed
Select 1 - Rarely 2 3 4 - Most of the time
Seems to enjoy being around other people; is sociable and prefers not to be alone
Select 1 - Rarely 2 3 4 - Most of the time
Tends to dominates others when they are around; generally directs the activity in which he is involved
Select 1 - Rarely 2 3 4 - Most of the time
Participates in most social activities connected with the school; can be counted on to be there if anyone is
Select 1 - Rarely 2 3 4 - Most of the time
Excels in athletic activities; is well coordinated and enjoys all sorts of athletic games
Select 1 - Rarely 2 3 4 - Most of the time

Please use this space to provide any additional information you would like the placement committee to consider, including your child’s greatest strength and why.