Guiding Academically Talented Exceptional Students

New Richmond Exempted Village School District

Gifted Education Program

Peer Referral Form for Gifted Identification

Completed forms should be returned to Mrs. Phillips, Gifted Coordinator

Your Name: _____________________ Person Being Referred: ___________________

Date: ____________ Your Grade: ________ Referred Student Grade: ____________

Answer the following questions as accurately as possible.  Feel free to use the back of this sheet or an additional sheet if necessary.

1.      How do you know the person you are referring?  How long have you known them?

2.      What things about this person led you to think that he or she should be in G.A.T.E.S.?

3.      Can this person work alone on a project?  If left alone, could this person finish their work?  Give an example, if possible.

4.      Does this person have a great memory?  Give an example, if possible.

5.      What is this person’s best subject in school?  Why do you say that?

6.      What is this person best at?  Why do you say that?

7.      Can this person be creative?  How?  Give an example, if possible.

8.      Does this person ask a lot of questions in class?

9.      Is this person one of the first people to finish their work?

10.  Tell one way that you are like this person and one way that you are different.