Gifted Program Interest Survey

Exit this survey

 

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1. Student's Last Name

Student's Last Name

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2. Student's First Name

Student's First Name

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3. Home Phone Number

Home Phone Number

4. Alt. Phone Number

Alt. Phone Number

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5. Mailing Address

Mailing Address

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6. Email address

Email address

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7. Student's Age

Student's Age

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8. Student's Current Grade

Student's Current Grade

9. (Optional) Current School District

(Optional) Current School District

10. (Optional) Current School

(Optional) Current School

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11. Which type of gifted program would you prefer?

Which type of gifted program would you prefer?   A virtual program An on-site program A blended program (virtual and on-site) Unsure

12. Please tell us about your student's interests, hobbies, or talents (including any organizations, clubs, and sports).

Please tell us about your student's interests, hobbies, or talents (including any organizations, clubs, and sports).

13. Please tell us about your student's academic performance and intellectual curiosity to date.

Please tell us about your student's academic performance and intellectual curiosity to date.

14. Why would you consider a gifted/talented program for your student?

Why would you consider a gifted/talented program for your student?

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15. Name of person completing this survey:

Name of person completing this survey:

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16. Relationship to the student:

Relationship to the student:

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17. Preferred Method of Contact

Preferred Method of Contact   Home Phone Alt. Phone Email