Parent/Guardian Statement Form

This statement is required for all new applicants.

Section

Child's Name:

E-Mail Address:

Parent/Guardian

First Name:

Last Name:

Instructions: Provide anecdotal information about this child's learning characteristics and abilities in each of the following areas. Be as specific as possible. This information is required to support your child's application for our program designed for children with advanced intellectual ability.

Language Acquisition and Use (Please provide specific examples of advanced ability):

Reasoning (Please provide specific examples of advanced ability):

Memory (Please provide specific examples of advanced ability):

Humor (Please provide specific examples of advanced ability):

Sensitivity (Please provide specific examples of advanced ability):

Creativity (Please provide specific examples of advanced ability):