PRINCE WILLIAM COUNTY PUBLIC SCHOOLS
GIFTED EDUCATION PROGRAM
PARENT OR GUARDIAN REPORT
GRADE SIX THROUGH GRADE EIGHT
(Print or Type)
Name of Student ____________________________ School ___________________Grade ____ Birth Date ___________
Name of Parent or Guardian
Address
(Street)
(City)
Home or Cell Phone
Home Email
Mother's Work Number
Mother’s Email
Father’s Work Number
Father's Email
(State)
(Zip)
Asterisk the phone number or numbers and Email address or addresses that you prefer we use to reach you.
Signature of Parent or Guardian
__________________________________________
Date _______________
Please complete the attached report:
Your responses are an important part of the identification process. We consider your responses as important to our process
as the information from standardized tests. You will notice that we are asking questions about your son’s or daughter’s
interests outside of school. As a parent or guardian, you can share information about your son or daughter as a learner from
your perspective that we would otherwise not be able to include in the identification process.
A. On page 2 and 3, respond to the statements.
Check the three statements on page 2 and the three statements on page 3 that best describe your son or
daughter.
B. On page 4, respond to all of the statements.
Make certain you refer to at least one of the statements you checked on page 2 and one of the
statements you checked on page 3.
C. On page 5, respond to those statements for which you can give specific examples.
We appreciate the time you have taken to complete this report. Thank you for your help.
The questions in the Parent or Guardian Report are available in additional languages and will be translated for any parent.
The Parent or Guardian Report may also be completed through an interview.
Please return this report to the Gifted Education Resource Teacher assigned to your building.
Resource Teacher _________________________________________________________________
Date Sent by Resource Teacher ________________ Date Returned to Resource Teacher __________________
Report adapted from identification materials from National Research Center on the Gifted and Talented at University of Georgia.
Revised August 2012
PARENT OR GUARDIAN REPORT
Directions: Indicate the degree to which the following phrases describe your son or daughter by circling N, S, O, or C.
Information Gathering
Mathematics
Language
N indicates that the statement does not describe your son or daughter.
S indicates that the statement describes your son or daughter sometimes.
O indicates that the statement describes your son or daughter often.
C indicates that the statement describes your son or daughter consistently.
Reads extensively
N
S
O
C
Writes or shares complex ideas using advanced vocabulary
N
S
O
C
Writes or shares complex or detailed or subtle poems or stories
N
S
O
C
Shares ideas effectively without using words
N
S
O
C
Learns large quantities of detailed factual information
N
S
O
C
Remembers factual information and shares the information through speaking or writing
N
S
O
C
Grasps difficult abstract mathematical concepts quickly
N
S
O
C
Explains complicated mathematical concepts logically
N
S
O
C
Uses numbers and calculations effectively to solve complicated problems
N
S
O
C
Understands geometric (spatial) concepts and can apply those concepts
N
S
O
C
Is fascinated by mathematical applications such as music, art, or robotics
N
S
O
C
Becomes completely absorbed in logic puzzles or strategy games
N
S
O
C
Uses Lego blocks or other materials to create original structures
N
S
O
C
Uses computer simulations to create inventive environments
N
S
O
C
Is interested in earth/space science, life science, or physical science
N
S
O
C
Researches detailed information in science and shares the findings
N
S
O
C
Is interested in history, geography, civics, economics, or current events
N
S
O
C
Researches detailed information in history or social science and shares the findings
N
S
O
C
Gathers information through extensive reading
N
S
O
C
Gathers information through selected television programs
N
S
O
C
Gathers information through exploring the Internet
N
S
O
C
Gathers information through hands-on experimentation
N
S
O
C
2
Revised August 2012
PARENT OR GUARDIAN REPORT
Directions: Indicate the degree to which the following characteristics describe your son or daughter by circling N, S, O, or
C. Typical behaviors that demonstrate the characteristic are listed under each of the characteristics. Your son or daughter
may demonstrate some or all of the behaviors. One behavior may be more dominant than others. Rate your son or daughter
according to the most dominant behavior.
N indicates that the statement does not describe your son or daughter.
S indicates that the statement describes your son or daughter sometimes.
O indicates that the statement describes your son or daughter often.
C indicates that the statement describes your son or daughter consistently.
Is Curious
Is a keen observer; Is curious; Has a questioning attitude;
Constructs “what if” or “if then” questions
Has a Vivid Imagination
Has a vivid imagination; Engages in role-play
Characteristics
Makes Connections
Transfers learning to new situations; Makes connections across subject areas;
Makes a mental connection between past experiences and present situations
Has a Sense Humor
Picks up on subtle or sophisticated humor; Communicate ideas in a humorous manner
Is Concerned about Fairness
Is concerned with right and wrong, good and bad, and the concept of fairness;
Evaluates and passes judgment on events, people, and things
Communicates Well
Demonstrates an unusual ability to communicate symbolically, artistically, or physically;
Uses particularly apt examples or illustrations
Has an Exceptional Memory
Has a large storehouse of information on school or non-school topics;
Has an exceptional ability to retain and retrieve this information
Has Intense Interests
Has intense, unusual, or advanced interests;
Is persistent in following through in work that interests him or her
Is Motivated
Is enthusiastic about learning new things and new ways of doing things
N
S
O
C
N
S
O
C
N
S
O
C
N
S
O
C
N
S
O
C
N
S
O
C
N
S
O
C
N
S
O
C
N
S
O
C
After circling each statement N, S, O, or C on pages 2 and 3, place a checkmark to the left of the three statements on page
2 and the three statements on page 3 that you consider the most important in describing your son or daughter.
Using only the lines below, indicate the greatest interest or interests of your son or daughter.
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3
Revised August 2012
PARENT OR GUARDIAN REPORT
Directions: Respond to all of the statements on this page. You may choose to respond more fully to any of these
statements on an attached sheet of paper.
Choose at least one statement you checked on page 2 and one statement you checked on page 3. Give one or more
examples of what your son or daughter has said, done, read, or written to illustrate the statements you have chosen.
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Describe how your son or daughter has expressed his or her personal interests as a learner through a unique creation or
design. This could be a solution to a problem he or she has recognized and worked to solve. It could also be a plan he or
she has developed and possibly implemented.
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Give an example of how your son or daughter used a past experience to explain a present situation or accomplish a current
task.
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Describe what you consider to be your son or daughter’s greatest strength in learning and his or her greatest challenge in
learning. If possible, tell how the strength and challenge are related.
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Describe any unusual circumstances that may affect your son or daughter’s performance at school, on class assignments,
standardized tests, or home projects.
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4
Revised August 2012
PARENT OR GUARDIAN REPORT
Directions: Respond to only those statements for which you can give specific examples. You may choose to respond more
fully to any of these statements on an attached sheet of paper.
Give one or two examples of books or articles your son or daughter has read within the past three months.
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Describe how your son or daughter uses numbers or math calculations in everyday situations.
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Give a brief description of writing your son or daughter has done, such as stories, poems, or research reports.
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Describe your son or daughter’s favorite logic puzzle or strategy game.
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Give an example of something your son or daughter has constructed using actual materials or computer simulations.
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Give examples of topics in earth/space science, life science, or physical science which your son or daughter is interested.
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Explain how your son or daughter gathers information about the science topics in which he or she is interested.
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Give examples of topics in history, geography, civics, economics, or current events in which your son or daughter is
interested.
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Explain how your son or daughter gathers information about the history or social science topics in which he or she is
interested.
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Include any additional examples you believe describe your son or daughter.
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5
Revised August 2012