SAMPLE

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

GIFTED AND TALENTED PROGRAM

MINIMUM SCORES APPROACH

GRADES K-5

STUDENT ID #_____________________ RECOMMENDED GT PLACEMENT: YES NO

NAME:___________________________________________________________________________

DATE OF BIRTH:________________AGE:_____SEX:_______

CAMPUS NAME:___________________________________________________________________________

GRADE:_____________ CONSIDERATION DATE:_____________________________________

INSTRUMENT/ METHOD	MINIMUM SCORE	ACTUAL SCORE	+ / -	COMMENTS
COGAT: QUANTITATIVE BATTERY
COGAT: NONVERBAL BATTERY
PLANNED EXPERIENCES
TEACHER CHECKLIST

III. 15.1