Center for Gifted Education P.O. Box 43251 Lafayette, LA 70504-3251 (337) 482-6701 Fax: (337) 482-1073 Université des Acadiens 2015 Center for Gifted Education PRE-K/K (Summer) Academic Enrichment Program Assessment Application Form TO BE COMPLETED BY PARENT/GUARDIAN or TEACHER I wish to refer entered kindergarten) Academic Enrichment Program. to be tested for the UL Pre-K/K (Age 4 or 5 who have not Current School (if in a school) Referring Parent/Guardian or Teacher Please attach a short recommendation stating why you are referring the student. You may have noticed distinguishable differences from age peers in the following areas: reading ability, sense of humor, curiosity, attention, and movement. They may have the ability to make abstract connections and/or demonstrate advanced perceptiveness. Include any information explaining why the student would benefit from the program. APPLICATION SECTION: TO BE COMPLETED BY PARENT/GUARDIAN- $50 Screening Fee Required with Form Child’s Full Name Sex: ____ M ____ F Year Child Will Enter Kdg Parent/Guardian(s)* Date of Birth_______ Home Phone #: Mailing Address Street Address/Box No. City State Zip Parish of Residence Parent(s)/Guardian’s Daytime Phone Numbers:* Parent/Guardian Parent/Guardian *Single-parent families should list only the parent who is legally responsible for this child. Parents’ E-mail Addresses Parent/Guardian Parent/Guardian Return completed application and $50 testing/admission fee to: Center for Gifted Education, P O Box 43251, Lafayette, LA 70504-3251. Assessment dates have been set for Friday and Saturday mornings in late January, February and early March. Go to http://ullcge.appointy.com/ or call Brenda Trahan at (337) 482-6701 to schedule your child’s assessment after you have mailed your form. Please make checks payable to UL Lafayette and write your child’s name in the memo section of the check. MACINTOSH HD:USERS:BETHMOORE:DROPBOX:CGE PRE-K APPLICATION FORM SUMMER 2015.DOC A Member of the University of Louisiana System Center for Gifted Education P.O. Box 43251 Lafayette, LA 70504-3251 (337) 482-6701 Fax: (337) 482-1073 Université des Acadiens PLEASE NOTE: We do not accept cash or credit cards. 2015 PRE-K/K ACADEMIC ENRICHMENT PROGRAM INFORMATION Preschool classes, for children ages 4 (by June 8) to 5 years of age, are designed to engage and nurture students’ developing strengths in language arts, number sense, problem solving, and the arts. DATES: JUNE 8-11, AND June 15-18, 2015 (M-TH morning & afternoon options available); TIME: 9-12, 1-4, or 9-4 SITE: EARLY CHILDHOOD LAB NEXT TO THE PICARD CENTER (OFF EAST DEVALCOURT ST) COST: $125 Half Day; $275 Full Day (includes lunch supervision) DEADLINE TO ENROLL IN SUMMER PROGRAM: May 1, 2015* Watch our website: http://curriculum.louisiana.edu/about-us/centers/center-gifted-education and our Facebook page https://www.facebook.com/center4giftedULL for more details!! *Assessment must be completed prior to program enrollment. MACINTOSH HD:USERS:BETHMOORE:DROPBOX:CGE PRE-K APPLICATION FORM SUMMER 2015.DOC A Member of the University of Louisiana System
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