Gifted Student Assessment Questionnaire
Please complete this form to assist in the identification and evaluation of students with gifted potential. Your honest and thoughtful responses are valuable.
Student Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Grade Level
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other
School Name
*
Person Completing this Assessment (Name and Role)
*
Relationship to Student
*
Please Select
Teacher
Parent/Guardian
School Counselor
Other
Please rate the following characteristics as observed in the student.
*
Rows
Rarely
Sometimes
Often
Almost Always
Advanced vocabulary and verbal skills
1
2
3
4
Exceptional problem-solving ability
5
6
7
8
Keen curiosity and desire to learn
9
10
11
12
Originality and creativity in ideas or work
13
14
15
16
Strong motivation and task commitment
17
18
19
20
Leadership among peers
21
22
23
24
Advanced sense of humor
25
26
27
28
Sensitivity to others’ feelings
29
30
31
32
Rapid learning and retention of new information
33
34
35
36
Preference for complex tasks
37
38
39
40
In which academic areas does the student demonstrate outstanding ability? (Select all that apply)
*
Mathematics
Reading/Language Arts
Science
Social Studies
The Arts (Music, Visual, Performing)
Other
How would you rate the student's overall intellectual ability?
*
1
2
3
4
5
Please provide any additional comments or specific examples that support your assessment of the student's giftedness.
Signature of Assessor
*
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