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Nomination Form

Student Name:
Grade:
DOB:
Parent/Guardian
Name:
Parent/Guardian
email and phone
number:
Nominator:
Relationship to
student:
Student is nominated for the following program:
k-3
4-8
Special Area of Consideration:
ESL/Bilingual:
Attention/Behavio
r:
IEP/504/Behavior
Plan
Primary Language
Spoken at home:
Other area of
concern:
How have you observed this student to be academically gifted?

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