Secondary Gifted Program
Student Information
* Required field
*
Student Last Name
*
Student First Name
Middle Initial
*
Sex
-- Select --
Male
Female
*
Language(s) spoken at home
*
Ethnicity
*
Birth Date
Birthdate is invalid
*
School Year
*
Student ID number
*
Current Building/Campus
*
Current Grade
Teacher
*
Parent Name
*
Email Address
Email address is invalid
*
Primary Phone #
Alternate Phone #
*
Street Address
*
City
*
State
*
Zip
Screening Areas
Check the box for each content area for which you request screening. Enter the name of your child’s current content area teacher(s) (if known) in the box(es) provided.
Screen my child in the following content areas:
*
Please request screening for at least one content area
Checklist
* Required field
Directions:
Select the number that best describes your child.
My Child …
Please provide an example where indicated.
Previous Screening
* Required field
*
Has your child previously been screened for the Katy ISD GT Program?
-- Select --
Yes
No
If yes, at which campus?
School year
*
Is your child currently served in any other special programs?
-- Select --
Yes
No
*
If yes, identify the program:
Please specify
*
Does your child receive testing accommodations through special programs?
-- Select --
Yes
No
What additional information about your child would you like for us to know?
Agreement
I give my permission for the district to collect additional information about my child. I also give permission for my child to be served in the GT program if he/she is identified for placement.
*
Parent/Guardian Signature
Form Closed
This form is not currently open. Please refer to the GT Window Testing Dates.
Screening Windows Chart