Gifted/Talented Services Referral Form Hempstead Independent School District

I, ____________________________________, as parent/guardian/teacher/community (Please circle)

(Please print)

member would like to refer ______________________________ for the Gifted/Talented (Print student’s name)

screening and assessment process. I believe this child has an extraordinarily high level of intellectual or academic ability and that his/her educational needs can best be met by Gifted/Talented Services. I understand the school district will make every effort to determine the best possible educational services based on the student’s educational needs. This child is currently in grade _________ and ______________ is his/her (Print teacher’s name)

homeroom teacher.

_________________________________________ Signature of person making referral

_________________________ Date **Please return to Diana Wood prior to December 20, 2019. For Office use only: Date Received: ________________

Permission to Test sent: ________ (date)

Received by: __________________

Permission to Test received: _____(date)

**Front Office: Please send to Curriculum – Attn: Diana Wood

Formulario de referencia de servicios para Dotados / Talentosos Distrito Escolar Independiente de Hempstead

Yo, ____________________________________, como padre / tutor / maestro / miembro de la comunidad me gustaría referir a ______________________________ Escriba el nombre del alumno(a)

para el proceso de evaluación de Dotados/Talentosos. Creo que este niño tiene un nivel extraordinariamente alto de capacidad intelectual o académica y que sus necesidades educativas pueden ser satisfechas mejor con los Servicios para Dotados/Talentosos. Entiendo que el distrito escolar hará todo lo posible para determinar los mejores servicios educativos posibles basados en las necesidades educativas del estudiante. Este niño(a) está actualmente en el grado _________ y ______________ es su maestro(a) de aula.

_________________________________________ Firma de la persona que hace la referencia _________________________ Fecha

**Por favor regrese a Diana Wood antes del 20 de diciembre de 2019. For Office use only: Date Received: ________________

Permission to Test sent: ________ (date)

Received by: __________________

Permission to Test received: _____(date)

**Front Office: Please send to Curriculum – Attn: Diana Wood