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610.1P - Application to Serve on the Gifted and Talented Advisory Council

610.1P - Application to Serve on the Gifted and Talented Advisory Council

Adopted: June 2006
Revised: October 2019

 

Download 610.1P - Application to Serve on the Gifted and Talented Advisory Council

 

 

Name (please print)  ________________________________________________________

                                                           first                                                           last

 

 

Address ____________________________________________________________________

city                                                                                                        zip code

 

Phone (           )                          Email _____________________________________

 

 

Occupation ________________________________________________________________

 

What is your connection to the school district? (Please check all that apply.)

 

1. Parent/guardian of an identified gifted and talented child(ren) 

 

Please specify each child’s school and grade:

 

School ___________________________________Grade _________

 

School ___________________________________Grade _________

 

School ___________________________________Grade _________

 

2. District employee:

         elementary gifted and talent development teacher

           elementary classroom teacher

               elementary principal

           middle school gifted and talent development teacher/coordinator          

           middle school classroom teacher

               middle school principal

           high school honors/advanced placement (AP) teacher

               high school administrator       

 

3. High school student: School  ____________________ Grade ___________

 

What expertise can you bring to the Gifted and Talented Advisory Council?                                                                                                                   

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

 

Procedure 610.1P

Page 2

 

What is your experience and/or education related to gifted education? ____________________________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

Why are you interested in serving on the Gifted and Talented Advisory Council? ____________________________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

_________________________________________________________

 

List two references:

 

1. Name _______________________________  (_______)_____________  (_______)_____________

                                                                                                              daytime phone                               evening phone

 

Relationship _____________________________________________________________________

 

2. Name _______________________________  (_______)_____________  (_______)_____________

                                                                                                              daytime phone                               evening phone

 

Relationship _____________________________________________________________________

 

 

 

                                                                                                                                 

                                    signature                                                                                                       date

 

 

THANK YOU FOR YOUR INTEREST!  Please submit this completed application to:

Director of Teaching and Learning, Independent School District 196,
3455  153rd Street West, Rosemount, MN  55068 or fax it to: 651-423-7614.