NORWALK PUBLIC SCHOOLS, NORWALK, CT

Academically Talented Program

Parent Nomination Form – Elementary School

 

Name of Student ________________________________________________  Age ___________

Address _______________________________________________________________________

              ___________________________________________________ ZIP ________________

School   ________________________________________________ Grade ________________

 

Instructions:  In relationship to the typical child in your neighborhood, please circle a number for each item which best describes your child:  5 - has this trait to a high degree; 4 – has this trait more than the typical child; 3 – compares with the typical child; 2 – has this trait less than the typical child; 1 – lacks this trait.

 

1.  Has advanced vocabulary, expresses himself

or herself well                                                             5     4     3     2     1         

 2.  Thinks quickly                                                                         5            4            3            2            1

 3.  Recalls facts easily                                                                                5            4            3            2            1

 4. Wants to know how things work                                        5      4      3      2      1

 5. Is reading (before he/she started Kindergarten)                     5      4      3      2      1

 6.  Puts unrelated ideas together in new and different ways                5      4      3      2      1

 7.      Becomes bored easily                                                          5      4      3      2      1

 8.  Asks reasons why – questions almost everything               5      4      3      2      1

 9.  Likes “grown-up” things and to be with older people              5      4      3      2      1

10. Has a great deal of curiosity                                            5      4      3      2      1

11. Is adventurous                                                                 5      4      3      2      1

12. Has a good sense of humor                                               5      4      3      2      1

13. Is impulsive, acts before he/she thinks                                 5      4      3      2      1

14. Tends to dominate others if given the chance                                5      4      3      2      1

15. Is persistent, sticks to a task                                                      5      4      3      2      1

16. Has good physical coordination and body control                    5      4      3      2      1

  1. Is independent and self-sufficient in looking after

himself/herself                                                                                      5            4            3            2            1

  1. Is aware of his/her surroundings and what is going

on around him/her                                                                         5            4            3            2            1

      19. Has a long attention span                                                                 5            4            3            2            1

  1. Wanted to do things for himself/herself early –

Example:  dressing and feeding himself/herself                         5            4            3            2            1

                                                                                                                                   

Please see Side 2

 

 

 

Side 2

 

If there is anything about your child that has not been covered in this form, please feel free to include that information below.

 

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Parent Signature ________________________________________________ Date _______________________