Riverview School District
Program for Academically Talented (PAT)
1st Grade CogAT Screener Opt Out I/we do not want my/our child _____________________________________ to participate in the upcoming CogAT screening. I/we understand that these assessments are a part of the required criteria used to determine qualification for the Program for Academically Talented (PAT) Highly Capable/Gifted program. Reason:____________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ School:______________________________ Teacher:_______________________ ___________________________________________ _____________________________________ Parent/guardian signature Date Please return this form to your child’s school office or to Mary Jacobson by December 17th at the address listed below. Thank you Mary Jacobson PAT Program Assistant 4950 Tolt Ave Carnation, WA 98014 (11/2014)