LOS ANGELES UNIFIED SCHOOL DISTRICT
GIFTED/TALENTED PROGRAMS
ATTACHMENT A
2015–2016 APPLICATION FOR TRANSFER TO A SCHOOL FOR ADVANCED STUDIES (SAS)
Application period is from April 7 through April 30, 2015.
For students who are residents of LAUSD only. Transportation is not provided.
The entrance level to SAS programs is from grades K–12. Processing is dependent upon accurate and complete information.
Please PRINT in INK and fill out completely. Completed application should be submitted to the SAS School of Choice.
A
I. SAS School of Choice (SAS site to which student is applying)
A
II.
Student Last Name
First Name
Initial
First Name
Initial
A
III. School of Attendance
A
IV. Parent/Guardian Last Name
A
V. Home Address
Apt. /Unit No.
A
VI. City/State
ZIP Code
-
-
VII. Area Code
Home Phone
Area Code Work or Emergency Phone
VIII. Student Information and Eligibility Criteria: (School staff must sign and confirm student’s eligibility by completing pages 2–3.)
Student Ethnicity (Check one)
1. American Indian/Alaskan Native
4. Latino
2.
Asian
5. White
Student’s Grade Next School Year
3. African American or Black
6. Pacific Islander
Please check ONE of the following criteria and provide supportive documentation (e.g., test score report, if applicable):
Student is on current wait list for the gifted/high-ability/highly gifted magnet If yes, submit copy of notification letter.
Yes
Intellectual
High Achievement
Creativity
Leadership
1) Student is identified as gifted/
Specific Academic:
English
Math
Science
Social Science
talented:
Yes
No
2) Student has TOTAL national scores of 85% or above for most recent year (new/out-of-district/OLSAT-8):
Yes
No
Indicate TOTAL national scores in Reading/Composite
or Verbal Reasoning
or APR Verbal (OLSAT-8)
AND Mathematics/Composite
or Quantitative Reasoning
or APR Non-verbal (OLSAT-8)
3) Student meets ALL FOUR critical-thinking and problem-solving skill criteria and demonstrates the ability or strong
potential to perform two years above grade level in academic subjects.
Yes
No
(School staff must complete additional verification items for criterion 3, pages 2–3.)
Birth date
/
/
IX. Signature of Parent/Guardian
________________________________E-mail
(Signature acknowledges awareness that the SAS program does not provide transportation services.)
Date
________________________________________________________________
X. Signature of Administrator (or designee) of Current School of Attendance
Date
(Signature acknowledges request to transfer and that student meets eligibility criteria; sending school must keep
supporting evidence on file at school site for five (5) years; subject to audits.)
XI.
_______________________________________________________________
Signature of Administrator (or designee) of SAS School of Choice
Date
(Signature acknowledges receipt of application.)
FOR OFFICE USE ONLY (Receiving School/SAS School of Choice)
APPLICATION APPROVED
APPLICATION DENIED
WAITING-LIST NUMBER
BY:
POSITION:
STAPLE AND DUPLICATE APPLICATION BACK-TO-BACK BEFORE DISTRIBUTING.
MEM-5974.2
Office of Curriculum, Instruction and School Support
Page 1 of 3
March 12, 2015
LOS ANGELES UNIFIED SCHOOL DISTRICT
GIFTED/TALENTED PROGRAMS
ATTACHMENT A
APPLICATION PROCESS:
The application must be completed and signed by the parent/guardian and the principal/designee of the school of
attendance, and submitted to the SAS school of choice. For the appropriate educational placement of very young
children (K–1), it is recommended that a brief interview and review of work samples be included to complete a
student profile. The teacher or administrator familiar with student’s eligibility must also sign the application (see
below).
CRITERIA: TO BE COMPLETED BY SCHOOL ADMINISTRATOR/DESIGNEE
SAS sites are open to applicants currently in grades Pre-K–11 who reside within the LAUSD boundaries AND who
demonstrate superior academic achievement. The student’s current school of attendance must verify that the applicant
meets ONE of the following criteria:
Note:
Students currently on the magnet waiting list for gifted/high-ability or highly gifted magnet centers are eligible
and may apply. Copy of the notification letter must be submitted with application.
1. Students identified as gifted/talented in the Intellectual, High Achievement, Specific Academic, Creative Ability,
or Leadership Ability Categories.
2. Students who have TOTAL national scores of 85% or above on a District-approved standardized achievement
test in required areas. Indicate percentile in:
Total Reading/ELA:
and Total Math:
Reading Composite:
and Math Composite:
Verbal Reasoning:
and Quantitative Reasoning:
Total (APR) Verbal (OLSAT-8):
OR
OR
OR
and Total (APR) Non-verbal (OLSAT-8):
3. Students who demonstrate mastery of ALL FOUR of the critical-thinking and problem-solving skills in their
primary language (must check “Yes” for all four skills for the student to qualify with this criterion):
Yes





No
Explain meanings or relationships among facts, information or concepts that demonstrate
depth and complexity. Examples:
Analyzes similarities and differences in events, people and things.
Displays high level observation skills that frequently detect fallacies and inconsistencies.
Grasps new concepts easily; moves rapidly from familiar (concrete) to unfamiliar (abstract).
Sees hidden meanings or cause-and-effect relationships that are not obvious.
Analyzes and evaluates respective solutions from multiple points of view.
Yes
No Formulate new ideas or solutions and elaborate on the information. Examples:
 Plans unique projects by integrating learning from different areas.
 Produces detailed steps of a solution and sound reasons for them.
 Invents solutions to established problems; creates problems for which there are no apparent solutions.
 Approaches tasks in different, unusual, and original ways.
Yes





No Use alternative methods in approaching new or unfamiliar mathematical problems.
Examples:
Locates, selects, and uses relevant information and material.
Gives examples of possible outcomes; makes "educated guesses."
Thinks of and asks provocative questions which involve logical thinking processes.
Changes word problems into mathematical terms or formulas.
Uses standard math processes and proficiencies such as problem-solving, abstract reasoning,
constructing viable arguments, etc. (CCSS Standards for Mathematical Practice).
MEM-5974.2
Office of Curriculum, Instruction and School Support
Page 2 of 3
March 12, 2015
LOS ANGELES UNIFIED SCHOOL DISTRICT
GIFTED/TALENTED PROGRAMS
ATTACHMENT A
Yes
No Use extensive vocabulary easily and accurately to express creative ideas. Examples:
 Demonstrates a vivid imagination in a variety of products.
 Shows unusual ability to express self, feelings, concepts, etc.
 Plans and selects alternative means to demonstrate creative ideas.
 Demonstrates fluent, concise, and creative self-expression.
 Uses a large vocabulary in home language.
 Shows ability to “code switch” and uses language appropriate to specific disciplines, situations, and
audiences.
Applicants verified through the four critical-thinking and problem-solving skills must also demonstrate the
ability or strong potential to work two years above grade level in academic subjects. Please list most recent
grades below:
SUBJECT
GRADE
Language Arts - Reading/English
Language Arts – Writing (elementary only)
Mathematics
A student portfolio should be created to support verification or non-verification of mastery in ALL FOUR criticalthinking and problem-solving skills in student’s primary language AND ability to work at least two grade levels
above. The student portfolio should be kept on file for five (5) years in student cumulative record (do not submit
with application unless requested for K–1 applicants). Examples of documentation/supporting evidence that may be
included in the student portfolio are as follows:
 Writing sample(s) that showcase extensive vocabulary
 Drawings/multi-media files
 Annotations of class activities and discussions/journals/logs
 Examples of assignments and projects that demonstrate depth and complexity
 Examples of new or creative thinking
 Examples of students using alternative methods in approaching new or unfamiliar mathematical problems
(i.e.: constructed response)
 Letter of recommendation from person of choice (recommended current teacher)
 Formative and summative assessment examples (e.g. reading inventories showing above grade level
abilities)
 Cumulative project examples
VERIFICATION (Only a teacher or administrator can verify a student’s achievement.)
Print Name of Staff
Verifying Data:
Title:
Signature:____________________________________________________ Date:
School:
Phone: (
)
School Address (if private or Charter):
City/State:
MEM-5974.2
Office of Curriculum, Instruction and School Support
ZIP Code:
Page 3 of 3
March 12, 2015