Author: Jadkins

Nomination Form for G/T Services
This form has been developed to help locate students who demonstrate needs consistent with those of Gifted/ Talented students. Please rate how often the student demonstrates the indicated behaviors and give an example of each behavior seen. Both parts of your answers will be used in the screening process, please include a behavior for each example.
Student__________________________________ Grade_________ Age ___________________
Nominated by ________________________________ School ___________________________
Occurrence Factor

Frequent	Occasional	Seldom

1. Is curious, asks many questions; is interested in many different things.
Example:
2. Persists in explaining and exploring his/ her environment; has a long attention span. Example:
3. Is independent; pursues independent interests.
Example:
4. Has a great imagination, likes to pretend.
Examples:
5. Is full of ideas which he/she expresses verbally, is conversationally fluent.
Example:
6. Is bored by routine tasks.
Example:
7. Can occupy his/ her time wisely.
Example:
8. Likes to have his/ her ideas heard, has lots of ideas.
Example:
9. Reads intensively in areas of special interest.
Example:
10. Associates with and has interests similar to older children and adults.
Example:
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Name:_____________________________________ Grade: _________________
Occurrence Factor

Frequent	Occasional	Seldom

11. Is friendly and outgoing; enjoys other people, and seeks them out.
Example:
12. Is aware of problems others do not see or identify, initiates civic activities related to humanitarian or global problems.
Example:
13. Searches for new ways to do familiar tasks; is creative with commonplace materials.
Example:
14. Has an advanced sense of humor and appreciates puns and word play.
Example:
15. Has high expectations of self and others; demands to know why and how things occur.
Example:
16. Is a loner, enjoys being uninterrupted in his/ her study or exploration.
Example:

Other comments from nominator:
Committee Comments: