Guiding Academically Talented Exceptional Students

New Richmond Exempted Village School District

Gifted Education Program

Referral Form for Gifted Identification in Visual and Performing Arts

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

Student _____________________ Grade __ School ___________ Teacher _______________

Address __________________________ Zip ________ Phone ___________ Date _________

Criteria: One check in any category qualifies a student for screening in that category.

Visual Arts

____ Elaborates on ideas from other people’s ideas and uses them as a jumping point as opposed to copying from others.

____ Shows unique selection of art media for individual activity or classroom projects.

____ Has unusual and richly imaginative ideas.

____ Composes with detail and skill.

____ Displays compulsive artistic pursuit.

Music

____ Matches pitch accurately.

____ Is able to duplicate rhythms correctly.

____ Demonstrates ability on an instrument, including voice.

____ Has a high degree of aural memory/musical memory.

____ Displays compulsive musical pursuit.

Drama/Theatre

____ Readily shifts into the role of characters, animals, or objects.

____ Communicates feelings by means of facial expression, gestures, and bodily movement.

____ Uses voice expressively to convey or enhance meaning.

____ Easily tells a story or gives a vivid account of some experience.

____ Volunteers to participate in classroom plays or skits.

Dance

____ Demonstrates physical balance.

____ Performs sequences of movement easily and well.

____ Communicates meaning and feeling with movement.

____ Accepts his/her body as an instrument of expression.

____ Volunteers to participate in movement activities and dances.

___________________________________________________                             ___________

Signature of person initiating referral and relationship to student                                   Date

___________________________________________________                             ___________

Parent signature (Required for testing)                                                                       Date