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