SOUTHERN HIGHLANDS
ACADEMICALLY GIFTED (A.G.) CLASS
APPLICATION FORM
STUDENT DETAILS
Student’s Name:______
Date of Birth:______Male/Female: ______
Address:______Telephone No: ______
______Post Code: ______
Parent/Carer’s Name(s): (1) ______(2) ______
Present School:______Class: ______Grade:______
Did this childsit the test last year for the A.G. Class? YES/NO
Would you like to reactivate their application score from last year’s testing? YES/NO
Teacher: ______School Telephone: ______
Cognitive Assessment (if any school results available) Test:______
Counsellor: ______Results: ______Test Date: ______
Please note that it is a condition of any offer of a place that the child is eligible to enrol in a Southern Highlands Public School and that enrolment must be taken up prior to commencement of the AG Class program.
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Principal’s Statement/Recommendation ______
Principal: ______Date: ______
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LANGUAGE BACKGROUND
Language spoken at home: ______
If ESL, years speaking English:______
HEALTH INFORMATION
Vision:______Hearing:______
Other Medical Issues: ______
______
Medication: (If taken at school, indicate dosage, time, administered by whom?)______
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Other Agencies Involved: (Indicate nature of involvement and date(s))______
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ADDITIONAL COMMENTS:______
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Class Teacher Nomination Form for the Academically Gifted Class
CLASS TEACHER NOMINATION FORM
Student’s Name: ______File: ______Date of Birth: ______
Address: ______Teacher: ______
School: ______Phone No: ______Grade: ____ Date: ______
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This student is being considered for the gifted and talented program in our district. Could you please take a few moments to complete this form. Your cooperation is greatly appreciated!
Please rate the student on the following characteristics on a 0—3 points scale:
(0) NEVER(1) RARELY(2) SOMETIMES(3) ALMOST ALWAYS
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CHARACTERISTICRATING
Displays a great deal of curiosity and is highly imaginative0123
Has a well developed sense of humour.0123
Learns quickly and easily.0123
Is persistent in completing tasks of interest.0123
Asks many questions about a variety of subjects.0123
Knows about many different things.0123
Has a large advanced vocabulary.0123
Has a good memory and superior reasoning.0123
Has a high motivation to learn/independent learner.0123
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NAPLAN Results– Please attach copy of band results on graph (or state why these are not available)
______
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Do these NAPLAN results reflect the child’s usual performance in your class? : YES/NO
If not, why not?______
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Any additional comments:______
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CLASS TEACHER REPORT
Student Name: ______
What is this student’s main area(s) of strength?______
Is this student an underachiever?YES/NO
Does this student have learning problems?YES/NO
If YES, please specify area(s) of concern.—————————————————————
______
Has this child accelerated or repeated any classes?YES/NO
If YES, please indicate which grade.______
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Teaching Programs:
State briefly what has been done at the home school to enrich this student ______
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Student’s main area of interest: ______
______
Social adjustment: How does this child relate to peers? ______
______
Emotional adjustment: How does this child cope with changes? ______
______
If the student is in year five, how will this student cope with working with year six students? _____
______
Behaviour: Is this student’s behaviour a problem in the classroom or in the playground? ______
If so, give details of behaviour. ______
______
Further comments about this student/or the class you wish to add: ______
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General comment - any further relevant information ______
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CLASS TEACHER
NOMINATION BY PARENT OR CAREGIVER
Student’s Name: ______Year ______
Person completing the form: ______Relationship to student______
Characteristic Most of the timeSome of the time Rarely
Recalls facts easily
Expresses himself/herself fluently
Is always asking questions
Has a sense of humour
Finds unusual uses for things
Tends to lead/initiative activities
Is curious
Has long attention span
Is easily bored
Is an avid reader
Thinks logically
Mixes with older children and adults
Is impulsive
Is an independent learner
Is concerned about world issues
When did your child first begin to read? Is he/she self-taught______
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At what age did your child show an understanding of numbers, puzzles and patterns?______
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How may books and magazines would your child voluntarily read in a month?______
______
Does your child have any unusual interests? If so, what are they?______
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What type of television programs does your child like to watch?______
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Does your child have an interest in music? Is so, what is he or she learning and what level has been attained?____
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In what activities does your child participate outside school hours______
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What hobbies and interests does your child have?______
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Would you consider that your child has a particular problem or need that may affect his or her learning?______
______
Please add any other information you may feel relevant to your child’s education______
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