SAMPLE

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

GIFTED AND TALENTED PROGRAM

PARENT NOMINATION FORM

I would like to nominate my child, ______________________________, for the XYZ Charter School Gifted and Talented Program. I understand that my desire to have my child considered includes permission to give him/her additional tests if necessary.

________________________________________ __________________________________

Parent Signature Date

Parent Name _______________________________________________________________

Address ___________________________________________________________________

City, State, Zip _____________________________________________________________

Home Phone _______________________________________________________________

Work Phone _______________________________________________________________

Cell Phone _______________________________________________________________

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