Challenge Pre-Screening Committee - Special Education Department

GIFTED SCREENING REQUEST FORM 2012-2013

Date Received Office use only

Students need to be screened to determine whether they will be designated as having special needs according to our district criteria. Students Name: Birthdate: Parent (s)/Guardian Address: Postal Code: School: Grade Years in District Classroom Teacher Referral to School-Based Team initiated by:
Parent Classroom Teacher Gifted Teacher Other (Please indicate)
First & Last Name(s)

Warren Zhu

Chartwell Elementary School

Supporting Documentation: Record of intervention (mandatory) Also may include: Examples of schoolwork Copies of report card Teacher/counsellor observations Private psychoeducational assessment.

Special Education Department-Challenge Dept.

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PREVIOUS FORMAL ASSESSMENTS Type of Assessment Agency

Date

CLASSROOM TEACHER'S OR GIFTED LEARNING RESOURCE TEACHERS COMMENTS AND OBSERVATIONS, INCLUDING ANY RELEVANT SOCIAL/EMOTIONAL/BEHAVIOURAL CONCERNS Please attach comments on student's strengths and special interests, difficulties, effort, attitude, work habits, behaviour and peer relationships.
Warren is a unique, witty, quirky, positive individual. His mathematical reasoning and overall mathematical understanding is far superior than that of his peers. Warren craves challenge in Math. He loves Math word problems and logical reasoning problems and invents strategies to solve them. He often introduces strategies to the class that we have not covered and when he wants to share his strategies, he often loses the attention of the class, as it is too advanced for the other members of the class! Warren likes to share his own problems with the class and stump his classmates. He wants to share his own problems every single Math block. Warren is a voracious reader and is competing for the top spot in our Reading Stars competition. He met Kenneth Oppel at a writers workshop and now has become obsessive over his books (previous to this, it was the Inkheart series). Warren participates in two Lit Circle groups concurrently and is a leader in each meeting he attends. Warren is currently working on his writing he is very aware of his strengths and needs. He has made it a goal to improve his writing, and it has come quite a long way since last year. This year, Warren has emerged as more of a social leader. He seems more confident in social settings and he always has in academic settings. His humour and personality is shining brighter this year. He is also allowing his competitive nature show more this year. Warren is thoroughly enjoying the Gifted intervention this year. I think he is benefiting from working closely with like-minded peers. Warren would benefit greatly from having an IEP and participating in Gifted seminars and also receiving Gifted support at school.

ATTACH SCHOOL BASED TEAM MINUTES AND A BRIEF HISTORY OF INTERVENTION (Please describe intensity and duration of instruction) e.g. Jason was seen for challenge service intervention focussing on math curriculum extension three times a week for twenty minutes a session in a group of five students for three months.

Special Education Department-Challenge Dept.

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LIST ALL SERVICES THE STUDENT IS CURRENTLY RECEIVING Counselling Other agencies Speech/language Other

WHAT MIGHT THIS ASSESSMENT ACCOMPLISH? Please specify what questions you have about the student that an assessment might address. This section to be filled out by the Gifted Learning Resource Teacher and the classroom teacher.
I believe Warren would benefit from having an IEP throughout his school career to ensure that he challenged and receives enrichment. We would like to see what strengths are highlighted in this assessment, apart from Mathematics.

Parent contacted by consent from parent provided for pre-screening.

on

and verbal

(School Based Team Chair)

(Print & Sign name)

(Date)

FORM TO BE RETURNED TO ALEX SWEENEY AT SPECIAL EDUCATION

Forms/Challenge Screening Request Form

Special Education Department-Challenge Dept.

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