SAMPLE

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

GIFTED AND TALENTED PROGRAM

PARENT PERMISSION FOR TESTING

I would like my child, ______________________________ considered for the XYZ Charter 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’s Signature Date

Please Print:

___________________________________________________________________________

Please print parent’s name

__________________________________________________________________________________________

Current street address

__________________________________________________________________________________________

City, State, Zip

__________________________________________________________________________________________

Home Phone Work Phone

III. 43