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:
VeryHigh
High Medium Low VeryLow
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 solving and pleasure in intellectual activities
14. Makes frequent and effective use of the library
15. Demonstrates the ability to think critically
16. Learns easily and readily
17. Exhibits keen powers of observation
18. Is a leader and accepts responsibility
19. Adapts readily to new situations
20. Understands and is sensitive to the feelings of others
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
CONFIDENTIAL TEACHER REFERRAL FORM
Please indicate any extra-curricular activities that you are aware this child takes part in (eg, performing arts, writing groups, sport, tutoring etc)
Other comments:
Teacher’s signature: Date: / /
Please complete this form and forward directly to Kathie Toth, Assistant Principal - Gleneagles Secondary CollegeFax: 9708 1324 or via email [email protected]
www.gleneagles.vic.edu.au / Reema Boulevard, Endeavour Hills VIC 3802 / T: 9708 1319 F: 9708 1324