Checklist for Talented Evaluations

SCHOOL BUILDING LEVEL COMMITTEE
TalentedFORMS
St. Landry Parish School Board
Revised by:
August 2016

Checklist for Talented Evaluations

Student:

School:

Section 1: Referral Information

Two-Page Screening Packet (Vision and Hearing addressed only if there is a concern)

Section 2: Screening Data

A. Talented Screening Data

Copy of teacher screener for talent area

REVISED: Jan. 2016

St. Landry Parish Talent Program Overview :

Louisiana offers special education services to students whose gifts and talents require special instruction not available in regular education settings. St. Landry Parish School System is looking for students who may be talented in music, theatre, and/or visual arts. These students are served through IEP’s (Individualized Education Programs) as part of the requirements of Bulletin 1706, Subpart 2, Regulations for Gifted and Talented Students. Students are served by itinerant talent professionals in the elementary grades .

Entry process:

Entry is based on the three-tier process consisting of a critique, a screening, and a state evaluation.

Critique: Your child will need to turn in a portfolio/CD of his or his or her work. Attached are the requirements of the portfolio/CD. We ask that you sign the permission slip for the critique and screening. Talent assessors will review your child’s performance via the appropriate portfolio/CD.

Screening: The students who have been recommended through the critique process in step 1 shall then be screened by a teacher knowledgeable of your child’s talent. This is a LA Department of Education requirement.

State Evaluation: If your child passes screening, he or she will then be referred for the state evaluation. You will be notified in writing as to time and place of the evaluation.

The St. Landry Parish School System adheres to procedures and criteria for the screening and evaluation of potentially talented students as stated in the Pupil Appraisal Handbook, Bulletin 1508. For more information, you may contact the office of Pupil Appraisal at 337-948-3646.

FOR PAC USE ONLY

Coordinator / Race / Gender / Case #

ST. LANDRY PARISH – PUPILAPPRAISALCENTER

CHILD IDENTIFICATION

Screening Packet - Page 1

CHILD FIND
STUDENT
First / Middle / Last
PHYSICAL ADDRESS
Street / Highway / City / State / Zip Code
MAILING ADDRESS
(if different)
Street / Highway / P. O. Box / City / State / Zip Code
DOB / AGE / RACE / GENDER
Years Months
District
Number / PRIMARY LANGUAGE
HEAD OF HOUSEHOLD - FATHER MOTHER GRANDPARENT FOSTER OTHER
FATHER
First / Middle / Last
MOTHER
First / Middle / Maiden / Last
GUARDIAN
First / Middle / Last
Home Phone / Work Phone / Emergency Phone
and/or Cell Phone
SCHOOL / TEACHER / GRADE
Referred by / Position / Race / Gender

COMPLETE FOR RE-EVALUATION or WAIVER ONLY:

Exceptionality / Sped. Teacher / Case # / Date of Last Evaluation
REASON FOR REFERRAL: / SPECIFY CONCERNS:
Initial Evaluation
Reevaluation / Mandatory Reevaluation
Results of Manifestation Determination
Declassification
Significant Change of Placement
New Concern
Gifted
Talented
Waiver
Preschool Screening
Court Decision / Due Process Hearing Decision
Other:

*Race: W-White B-Black H-Hispanic AI-American Indian A-Asian Revised August 2016

Screening Packet - Page 2
Student’s Name

CURRENT SCREENING RESULTS(Attach all necessary dated forms and documentation)

Area / Date / Normal/
Pass / At Risk/ Failed / No Concern / Date Corrected/Comments
Hearing
Vision
Sensory Processing
Health
Speech/Language
Motor
Assistive Technology
Soc./Emotional/ Behavior
Educational
REFERRAL RESULTS (Attach all necessary dated forms and documentation)
RTI Resultsmust include: current scientifically research-based intervention(s) implemented with fidelity and evidenced by data sheets, computer-generated records, or other permanent products; monitoring documentation of the student’s progress relative to peers, at reasonable intervals; and graphed evidence that the student’s rate of progress relative to peers is not adequate. (LA Bulletin 1508, 2009)
Lack of Progress Considerations must include: current data-based documentation that the student’s lack of educational progress is not primarily due to: lack of appropriate, explicit and systematic instruction in reading which includes the essential components of reading instruction: phonics, phonemic awareness, fluency, comprehension, and vocabulary; (e.g., if more than 50% of the class falls below benchmark on universal screening, lack of appropriate instruction might be suspected); lack of appropriate instruction in math (e.g., if more than 50% of the class falls below benchmark on universal screening, lack of appropriate instruction might be suspected); limited English proficiency; environmental or economic disadvantage (e.g., if a majority of low income students in the class fall below benchmark on universal screening, environmental or economic disadvantage as a primary factor might be suspected); or cultural factors (e.g., for students from culturally and linguistically diverse backgrounds, there is evidence that the school and classroom teacher have been sensitive toward the students’ diverse learning needs). (LA Bulletin 1508, 2009)
ALL OTHER FORMS AND DOCUMENTATION LISTED ONMandatory EvaluationCHECKLIST
GIFTED AND TALENTED SCREENING(Attach all necessary dated forms and documentation)
Gifted - include: Universal Screening, High Potential Checklist, Standardized Test Scores, etc.
Talented - must include: State Approved Screening Form and Parish Screening Instrument
Notification of SBLC Meeting sent on /

SBLC Meeting Date

SBLC Participants’ Signatures Required

Position

Race

Gender

Principal
SBLC Chairperson
PAC Representative
Parent

Teacher

Student

Revised 2016

PARENT PERMISSION FORM

ST. LANDRY PARISH TALENT PROGRAM

(MUSIC, VISUAL ARTS, THEATRE)

CRITIQUE AND SCREENING

Student Name: ______D.O.B.: ______

Contact Phone Number: ______Additional Number: ______

Grade: ______Teacher: ______School: ______

Homeroom Teacher: ______Referring Teacher: ______

Pupil Appraisal Member: ______

Check all that apply: ______Music _____Visual Arts _____ Theatre

Date: ______

Your child has been referred as being possibly talented and may qualify for the St. Landry Parish Talent Program. In order to critique and/or screen your child’s abilities, your permission is needed.

Your child will need to turn in a portfolio of his or her work to be critiqued. The SBLC Chairperson at the school will send home the portfolio requirements and a committee of talent professionals will review your child’s submission(s).

If your child meets criteria on both the critique and on the state screening instrument, he or she will be referred for a state evaluation. You will be informed of the results.

Please check the appropriate statement and sign below.Please return this form as soon as possible to your child’s teacher.

I give permission for you to conduct the critique and/or screening of my child,

______

(Child’s name)

I do not give permission for you to conduct the initial critique and/or screening of my child, ______

(Child’s name)

If your child was referred for music, check the appropriate box (s) below:

___ Vocal ____ Play Instrument (s)

Types of instruments(s): ______

Parent Signature: ______Date: ______

SLP-TALENTED MUSIC SCREENING INSTRUMENT

STUDENT NAME-______SCHOOL: ______DATE: ______

PERSON REFERRING: ______JOB/POSITION: ______

DIRECTIONS: Please rate the student on each of the following circling the appropriate number. Each rating should also have an example.

Shows interest in enjoyment of musical activities.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Is eager to participate in musical activities.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Is sensitive to the rhythm of the music; responds through body movements to changes in tempo of music.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Shows exceptional and/or fluent use of creative, original, or divergent ideas. (Makes up songs)

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Plays one or more musical instruments) or expresses a desire to); and/or sings with confidence.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Demonstrates a high level.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Is recognized by peers as talented in music.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Total: ______(add all circled numbers)

REQUIREMENTS FOR ASSESSMENT

TALENTED MUSIC

Date: ______Student: ______

Your child has been referred as being possibly musically talented. A process has begun which may qualify him or her for the Talented Music Program. Please have your child submit selections of music as listed below. Your child’s music will be critiqued by a committee of music professionals and you will be informed of the results. At least two selections should be recorded on a compact disk (cd) or jump drive. This recording should be clearly labeled with your child’s name, school and grade. If you have any questions, please contact ______at ______.

SBLC Chairperson School Phone#

This submission must reach the school SBLC Chairperson no later than ______.

MUSIC REQUIRED FOR ASSESSMENT

Selections of music should be from an area in which the student is comfortable.
The selections should be loud and clear with no background or distracting noise.
Before performing each selection your child should clearly announce their name, age, school and the title of the musical selection to be performed.
If the student is talented in both voice and instrument, one or more examples of each may be recorded.
Two selections are mandatory but more are allowed.
Your child must sing or play an instrument alone – accompaniment of any kind is not allowed!
You may include copies of any certificates of participation or awards that your child may have received in music with his or her recording.
Please keep all recorded materials and paperwork properly labeled with child’s name, age, and school.

Please note:

Your child’s selections recorded for this process may need to be performed if he or she qualifies for the evaluation. If your child is being referred for multiple talent areas, submit CDs or jump drives SEPARATELY for each area. This CD or jump drive may not be returned.

If you have any questions please contact ______at ______.

Music Portfolio Guidelines

In preparing a portfolio, applicants are to record at least two samples of their musical abilities for the local screening process. Successful performance through any of these guidelines will reveal the talents sought after by the Talented Music Program.

Band or String Instrument

Solo and Ensemble prepared piece
Methods book exercise demonstrating your strengths
Prepared audition pieces for all-state, honor ensemble or school class placement
Prepared pieces of contrasting style demonstrating knowledge of chords, improvisation and or soloing.

Guitar, piano or other instrument

Piece from recital performance
Aurally prepared song of considerable complexity and mastery
Prepared pieces of contrasting style demonstrating knowledge of chords, improvisation and soloing.

Percussion

Rudiments
Scales for melodic percussion
Methods book exercise on various instruments
Popular song accompaniment part on drum set with fills and solos

Vocal (singing only)

Happy Birthday
Star Spangled Banner
Prepared audition of pieces for honor chorus of school class placement
Piece prepared for classroom choral performance.

SLP-TALENTED VISUAL ARTS SCREENING INSTRUMENT

STUDENT NAME-______SCHOOL: ______DATE: ______

PERSON REFERRING: ______JOB/POSITION: ______

DIRECTIONS: Please rate the student on each of the following circling the appropriate number. Each rating should also have an example.

Draws more than his/her peers.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Draws better than peers.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Volunteers to do art or art-like activities.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Referred to by others when drawing or making objects. (Others students refer to their work as being good0

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Brings draws or art made from home to school.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Sets high standards of quality for his/her work.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Reacts with interest to art activities and information.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Total: ______(add all circled numbers)

REQUIRMENTS FOR ASSESSMENT

Talented Visual Arts Portfolio

Grades 1-5

Date: ______Student: ______

Your child has been recommended as a candidate for the Talented Visual Arts Program, which fosters the development of exceptionally talented young artists. In order to assess your child’s qualification for the program, a portfolio of your child’s artwork will have to be submitted for review by a visual arts panel.

To submit a portfolio, please follow these guidelines:

Portfolios must include a minimum of four and no more than six artworks. All artworks must be original (done strictly by your child) and may include works done at home or at school.

The portfolio must also include at least one of the following drawings:

A Self Portrait: While looking in the mirror draw a realistic picture of yourself including your neck and shoulders. Use pencil on a piece of paper no smaller than 8 inches by 11 inches.

AShoe: Draw a close-up picture of a tennis (athletic) shoe and include details such as shoelaces, stitching, etc. Use a pencil on a sheet of paper no smaller than 8 inches by 11 inches.

A Landscape with House: Go outside of your home and draw your house (or apartment building, (including the yard and objects in the yard (trees, fences etc.). Show the front and one side of the house in your drawing. Use pencil on a sheet of paper no smaller than 8 inches by 11 inches.

Each artwork and the portfolio must be labeled with the student’s Name, Grade Level, and School.

Art works must be completely contained in a portfolio or large envelope (a homemade portfolio of corrugated cardboard or poster board folded and taped or stapled to make a folder will do fine). Please do not submit artwork in frames or under glass. Submit photographs of sculpture or works larger than 18 by 24 inches but please contact ______at ______.

Portfolios should be delivered to the school’s SBLC Chairperson in care of the child’s teacher by ______. Portfolios will be returned after the assessment of you will be notified of the results. If you have any questions please contact ______at ______.

PARENT PERMISSION FORM

ST. LANDRY PARISH TALENT PROGRAM

(MUSIC, VISUAL ARTS, THEATRE)

CRITIQUE AND SCREENING

Student Name: ______

D.O.B.: ______

Contact Phone Number: ______Additional Number: ______

Grade: ______Teacher: ______School: ______

Homeroom Teacher: ______Referring Teacher: ______

Pupil Appraisal Member: ______

Check all that apply: ______Music _____Visual Arts _____ Theatre

Date: ______

If your child meets criteria on both the critique and on the state screening instrument, he or she will be referred for a state evaluation. You will be informed of the results.

Please check the appropriate statement and sign below.Please return this form as soon as possible to your child’s teacher.

I give permission for you to conduct the critique and/or screening of my child,

______

(Child’s name)

I do not give permission for you to conduct the initial critique and/or screening of my child, ______

(Child’s name)

If your child was referred for music, check the appropriate box (s) below:

___ Vocal ____ Play Instrument (s)

Types of instruments(s): ______

Parent Signature: ______Date: ______

SLP-TALENTED THEATRE SCREENING INSTRUMENT

STUDENT NAME-______SCHOOL: ______DATE: ______

PERSON REFERRING: ______JOB/POSITION: ______

DIRECTIONS: Please rate the student on each of the following circling the appropriate number. Each rating should also have an example.

Is effective in communicating ides, directions, and feeling to others.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Shows leadership in group activities, but follows when appropriate.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Shows emotion and feels with others in shared school experiences.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Shows freedom in using facial expression, gestures, and body.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Shows ability to focus on activities at hand.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Stays on a task until it is successfully completed.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Shows imagination when deciding to proceed with a problem.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Responds to activities in elaborate detail.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Shows ability to mimic physical and vocal behavior of others.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Volunteers to perform in front of people.

Seldom or never: 1 Occasionally: 2 Average: 3 Usually: 4 Almost Always: 5

Example: ______

Total: ______(add all circled numbers)

REQUIREMENTS FOR ASSESSMENT

TALENTED THEATRE

GRADES 1-5

Date: ______Student: ______

Your child has been referred as being possibly talented in theatre. A process has begun which may qualify him or her for the Talented Theatre Program. Please assist your child in preparing a short video or CD that indicates your child’s abilities in drama. This will be critiqued by a committee of theatre professionals and you will be informed of the results. If you have any questions, please contact______at ______.

SBLC ChairpersonSchool phone number

This submission must reach SBLC Chairperson no later than ______.

SUBMISSION SUGGESTIONS

Grades 1-3 Students:

A video or CD should include clips of past performances, your child portraying his or her favorite characters or a chosen monologue.