REFUSAL OF SERVICES
Gifted and Talented – Advanced Learning Plan
POUDRE SCHOOL DISTRICT
I
___
understand that my child qualifies for
and Advanced Learning Plan at
___________ School.
I have met with the GT Site Coordinator and other relevant school staff, and the
criteria for an Advanced Learning Plan have been explained to me. I also
understand that an Advanced Learning Plan is completed for all students
identified in Poudre School District as “Gifted and Talented.” The
recommendation of the Gifted and Talented Site Coordinator and other relevant
teachers is that my child has an Advanced Learning Plan. However, as the
parent/guardian of this child, I do not wish for my child to take part in these
services at this time.
I have refused the services of an Advanced Learning Plan for my
child.
_______________________
Child’s Name and Student ID
_______
_____________________________
Parent / Guardian Signature
_______
Date
_____________________________
Parent / Guardian Signature
_______
Date
__
Gifted and Talented Site Coordinator
_____
Classroom Teacher
_____
Date
___
Date
______
Principal / Administrator
PSD Gifted and Talented
Created 3/10/2010
_____
Date