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Series 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?               

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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