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The teacher who spends the most time with the student each week should complete this form. The teacher is asked to submit this confidential Referral Form directly to the college, not via the parent. Student’s Family Name Given Name/s Teacher’s Name Mr / Ms / Mrs School School Telephone Number How long have you known this child? Please indicate the degree to which you believe the student demonstrates the following traits: Very High High Medium Low Very Low 1. Is an avid reader and selects books at a reading age above her/his chronological level 2. Is verbally proficient, has an advanced vocabulary 3. Has a wide range of interests 4. Has a broad attention span that allows him/her to persevere in problem solving 5. Has the ability to do independent work effectively 6. Shows initiative and originality in class work 7. Has a great interest in the nature of humanity and the world 8. Follows complex instructions easily 9. Has great intellectual curiosity 10. Demonstrates a superior ability in maths, particularly problem solving 11. Possesses powers of reasoning, of dealing with abstract concepts above her / his chronological age 12. Shows alertness and quick response to new ideas 13. Shows a keen interest in problem www.gleneagles.vic.edu.au / Reema Boulevard, Endeavour Hills VIC 3802 / T: 9708 1319 F: 9708 1324 FORM C SELECT ENTRY ACCELERATED LEARNING (SEAL) PROGRAM YEAR 7, 2021
