Series 610.1P - Application to Serve on the Gifted and Talented Advisory Council
Adopted: June 2006
Revised: October 2019
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?
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What is your experience and/or education related to gifted education? ______________
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Why are you interested in serving on the Gifted and Talented Advisory Council? _____
______________________________________________________________
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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.
Procedures/610.1P/10-03-19