Name:
Age:
Birthdate:
Test Date:
School:
Grade/Class:
Examiner:

Reason for Referral:

To determine whether Client's name meets school board criteria for identification as Gifted.

Assessment:

On the Wechsler Intelligence Scale for Children - Third Edition (WISC-3), an individually administered test of intelligence, Client's nameís  verbal I.Q. was in the      range, at the     percentile, performance I.Q. in the      range, at the     percentile, and full scale I.Q. in the     range, at the     percentile.  This means that Client's name scored better than     % of children his/her age on language-based tasks, better than     % of children his/her age on non-verbal visual-spatial tasks, and better than     % of children his/her age overall.  Client's name excelled on tasks measuring...  Some relative difficulties were experienced with tasks measuring...  These results were/were not consistent with scores on the           Achievement Test, a standardized group test which was administered recently.

Conclusion and Recommendation:

Test results indicate that Client's name does meet school board criteria for identification as Gifted.  Placement in a special education program for Gifted children is recommended.
     OR
Test results indicate that Client's name does not meet school board criteria for identification as Gifted.  Nevertheless, enrichment activities in the regular classroom are recommended.
 

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Name
Position