PRESIDENTIALADVISORYBOARDFOR-PBworks.docVIP

PRESIDENTIAL ADVISORY BOARD FOR THE IDENTIFICATION OF GIFTED AND TALENTED YOUTH OHMICHIANA STATE BOARD This application for admission of your child to the National Gifted Program (NGP) must be submitted to the Federal Bureau of Investigation, Case Verification Division, Washington, D.C., 6 months prior to the child’s anticipated entry. All answers must be entered in the spaces allotted. PERSONS REPORTING FALSE INFORMATION WILL BE PROSECUTED IN FEDERAL COURT. PARENTS FATHER MOTHER Name: Herman Edder Name: Ann Edder Age: 31 Race: Caucasian Age: 30 Race: Caucasian Place of Birth: Germany Place of Birth: Germany Nationality: American Nationality: American Occupation: Electrical business (bankrupt) Occupation: Housewife Religion Preference: no religious denomination Religion: none Educational Level: High School Educational Level: High School Interests: reading Interests: music CHILD APPLYING FOR N.G.P. Name: Sam Edder Age: 12 Educational Level: grade 8 DO NOT WRITE BELOW THIS LINE FOR NGP SCREENING USE ONLY Height 5’9” Weight 120 lbs. Achievement Quotient 82 (out of 100) (incomplete exam) Creativity Quotient 110+ Social Quotient 74 (out of 150) School Behavior: very poor, considered unsociable and disturbed, handsome, thinks in pictures, values creativity, cocky contempt for authority General Physical Health: often sickly as a young child Congenital Abnormalities: none General Emotional Health: withdrawn, slight case of echolalia Special Interests: mathematics, frequently withdraws into fantasy world Special Skills: plays violin, likes to be alone to read Vocational goals: family expectation is engineering, but he states he does not find it interesting Vocational Contributions: none Evaluation of family stock: average Personal Goals: independence from family General Political beliefs: liberal, espouses ideas of freedom/democracy NGP C