Dallas Center – Grimes Community Schools
B.L.A.S.T. and T.A.G. Teacher Referral
Traits of Gifted Students









Cognitive Traits:









Learns rapidly and easily
Advanced vocabulary
Verbally fluent
Original and resourceful
Intolerant of routine tasks
Strong degree of task commitment
Comprehends complicated relationship
Highly curious and keenly observant
Broad scope of interests or an intense, specific interest
Affective Traits:
Emotional intensity
Acute sensitivity
Keen sense of justice
Needs consistency between abstract values and personal actions
Relates well to older children and adults
High expectations for self and others, could lead to perfectionism
Organizes things and people
Keen sense of humor
Feels different from others
Student Information:
Student Name:
Current Grade:
Gender:
Building:
Staff Information:
Referring Teacher:
Principal:
Date:
Talented and Gifted Teacher:
Directions for Referring Teacher:
1.
2.
3.
4.
5.
Review the Traits of Gifted Students above
Complete the Student Information Section and the Staff Information Section
Complete Sections 1-6 on the following pages
Attach copies of student work samples that reflect the traits of Giftedness above.
Present completed form to the building level TAG teacher
1
Version 3: January 2007
Section 1: Ability: Completed by Referring Teacher
Section One Ability:
Based on the observations of this student in your class, please respond to
the following:
A.
Uses unusually advanced vocabulary for age or grade level
B.
Has quick mastery and recall of factual information and concepts
C.
Exhibits a large storehouse of information about a variety of topics.
Understands and makes abstractions and generalizations quickly,
D.
enjoys analogies, puzzles, etc.
Perceives interrelationships; is able to analyze similarities,
E.
differences and cause and effect relationships readily or in-depth
Exhibits the ability to make decisions and judgments based on
F.
criteria and standards set by self and others
G.
Demonstrates and accepts leadership
Almost
Always
Sometimes
Seldom
Examples: Give an indication of how this student displays above ability in your classroom:
Section 2: Creativity: Completed by Referring Teacher
Section Two Creativity:
Based on the observations of this student in your class, please respond to
the following:
Displays questioning attitude, intellectual curiosity about many
A.
things; tries to discover the how and why of things
Has lots of ideas; sees many solutions to problems and questions;
B.
sees things from different perspectives; generates varied ideas or
solutions
Often offers unusual, unique, clever responses: elaborates, giving
C.
detailed steps or modifications to make ideas more complex,
complete and interesting
Is able to see implication; show judgment in evaluating things;
D.
makes decisions easily
Is a risk-taker: makes educated guesses, is speculative or skeptical,
E.
feels free to offer differing opinions; observes and reacts to
paradoxes, inconsistencies, and discrepancies
Displays a keen sense of humor and sees humor in situations that
F.
may not appear funny to others
G.
Has a strong sense of social justice; likes to debate issues
Almost
Always
Sometimes
Examples: Give an indication of how this student displays creativity in your classroom:
2
Version 3: January 2007
Seldom
3
Version 3: January 2007
Section 3: Task Commitment Completed by Referring Teacher
Section Three: Task Commitment
Based on the observations of this student in your class, please respond to
the following:
A.
Becomes intensely involved in certain topics or problems
B.
Sets own goals in interest areas
C
Shows initiative
D.
Follows plans to completion
E.
Develops quality products
F.
Does not give up easily
G.
Needs little teacher directions
Almost
Always
Sometimes
Seldom
Examples: Give an indication of how this student displays task commitment in your classroom:
Section 4: Learning Styles: Completed by Referring Teacher
What is this student’s preferred learning style(s)
Section 5: Classroom Enrichment: Completed by Referring Teacher
What classroom enrichments is the student receiving? Examples: Horizontal Enrichment, Curriculum
Compacting, In-depth Studies, Special Activities Related to the Regular Course Work.
Section 6: Concerns: Completed by Referring Teacher
What concerns do you have about this student?
4
Version 3: January 2007
5
Version 3: January 2007
This section is to be completed by the T.A.G. Teacher.
DO NOT GIVE THIS SECTION TO REFERRING TEACHER
Complete and attach the following section to teacher referral
AFTER the teacher has completed sections 1-5.
Directions for Building Level TAG Teacher:
1.
2.
3.
4.
5.
6.
7.
Review the information from the referring teacher on this form
Score Sections 1-3 on the teacher referral by give 5 points for every “Almost Always,” 3 points for “Sometimes,” and 1 point for
“Seldom.”
Complete Section 7 on Student Data
Bring subtotals for sections 1-3 and 7 forward to the table below
Recommend if student should participate in enrichment (Grade K-12) or if student should be identified as a TAG student (Grades 4-12)
Review recommendation with Building Level TAG Committee
Record final recommendation at the bottom of this form
Sections Subtotals: Completed by TAG Teacher
Subtotal from Section 1: Ability
_______ of a possible 35
Subtotal from Section 2: Creativity
_______ of a possible 35
Subtotal from Section 3: Task Commitment
_______ of a possible 35
Subtotal from Section 7: Enrichment or TAG Points
_______ of a possible 35
Grand Total of Sections 1-3
_______ of a possible 140
TAG Identification/Enrichment Guidelines for Recommendations
120 to 140 points
105 to 119 points
91 to 104 points
90 or fewer points
Excellent candidate for TAG or Enrichment
Good candidate for TAG or Enrichment
Marginal candidate for TAG or Enrichment. Review closely and carefully consider alternatives.
TAG or Enrichment is not recommended. Consider other classroom alternatives.
BLAST/TAG Committee Final Recommendation:
6
Version 3: January 2007
Section 7: Test Data: Completed by TAG Teacher
Part A: Ability Tests
Indicate which (if any) standardized ability tests the student has taken and the student’s grade level at the time of testing.
Ability test are designed to measure intelligence {IQ} and include, but are not limited to:







Wechsler Intelligence Scale
Otis-Lennon School Ability Test
Cognitive Ability Test
Slossen Intelligence Test
SAGES Tests
BESTS Test
Explore Test
If possible please attach results of any ability tests.
Part B: Achievement Tests
Attach copy of the most recent report card
Attach copies of past assessments from the HEART Data Base
Directions: Record the National Percentile Rank and circle the criteria/points for each score below.
TAG ID Points:
Most Recent ITBS Composite Total for TAG ID: _______
91th-92th %ile
93th – 94th %ile
14 points
21points
95th - 97th %ile
28 points
98th %ile or higher
35 points
Most Recent ITBS Reading Total for Enrichment:_______
91th-92th %ile
93th – 94th %ile
14 points
21points
95th - 97th %ile
28 points
98th %ile or higher
35 points
Most Recent ITBS Math Total for Enrichment:_______
91th-92th %ile
93th – 94th %ile
14 points
21points
95th - 97th %ile
28 points
98th %ile or higher
35 points
Most Recent ITBS Language Arts Total for Enrichment:_______
91th-92th %ile
93th – 94th %ile
95th - 97th %ile
14 points
21points
28 points
98th %ile or higher
35 points
Most Recent ITBS Science Total for Enrichment:_______
91th-92th %ile
93th – 94th %ile
14 points
21points
95th - 97th %ile
28 points
98th %ile or higher
35 points
Most Recent ITBS Social Studies Total for Enrichment:_______
91th-92th %ile
93th – 94th %ile
95th - 97th %ile
14 points
21points
28 points
98th %ile or higher
35 points
Most Recent SAGES Reading Total for Enrichment:_______
91th-92th %ile
93th – 94th %ile
14 points
21points
95th - 97th %ile
28 points
98th %ile or higher
35 points
95th - 97th %ile
28 points
98th %ile or higher
35 points
Enrichment ID Points:
Most Recent SAGES Math Total for Enrichment:_______
91th-92th %ile
93th – 94th %ile
14 points
21points
Most Recent SAGES Writing Total for Enrichment:_______
7
Version 3: January 2007
91th-92th %ile
14 points
93th – 94th %ile
21points
95th - 97th %ile
28 points
8
Version 3: January 2007
98th %ile or higher
35 points