Save my progress and resume later | resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

If you are not yet a member and are interested in attending PG Retreat for the first time, please complete the following application. The information you provide will be used solely for evaluating potential attendees and held in the strictest confidence.

Please direct any questions to application@pgretreat.com.

contact information

Contact name *

Street address *

Address continued

City *

State *

Zip *

Country *

Home

( )

Work

( )

Cell

( )

Email *

family members

Because PG Retreat is a family event supporting the social-emotional needs of profoundly gifted children, as well as those of their parents and siblings, please list all family members who may attend.

Parents / Guardians

	First	Last

			Add

Children/Other Family Members

	First	Last	Gender	Birthdate (if minor)
			MF
			MF		Add

For the following sections, please provide information regarding your profoundly gifted child or children. Answer all questions to the best of your ability, but note that no single piece of information, including test scores, is determinative. Evaluations are based upon the overall picture presented

background

Provide a brief description of your child, particularly as related to his or her PG qualities. Include examples of profound giftedness, lists of hobbies and intellectual interests, and anything else that may help us to "get to know" your child.

Describe any challenges your child has faced as a result of being profoundly gifted, including socially, emotionally, academically, etc. Discuss any challenges you have had as a parent raising a profoundly gifted child.

List your child's participation in any gifted organizations, summer enrichment programs, extracurricular activities and other relevant memberships.

expectations

Describe how you heard about PG Retreat and what your expectations are of what it is all about.

Describe what you are hoping your child will get out of PG Retreat.

Describe your child's expectations of and hopes for PG Retreat, if any.

Describe what you personally are hoping to get out of PG Retreat.

assessments

Provide the results of any intelligence tests your child has taken. List test(s), scores, and test administrators. For scores not indicative of PG levels, describe any relevant extenuating factors, such as ceilings, large spreads, and 2E issues.

Provide the results of any standardized aptitude or achievement tests your child has taken. List tests, scores, and ages taken.

Describe your child's current educational environment, along with any significant changes in environment. Identify the setting(s), such as public, private, parochial, homeschool, or community college. Describe any specialized gifted programs in which your child participates and discuss any grade acceleration undertaken.

references

List any references from professionals serving the gifted field, particularly any focused on the profoundly gifted. Note if any specifically advised you to attend PG Retreat. Provide names and contact information. If you wish, you may submit any written refereces by following the instructions at the end of this form.

List any references from other parents who have attended PG Retreat in the past who know your children. Provide names and contact information.

List any references from other professionals, such as teachers, who can attest to your child's gifted qualities. Provide names and contact information. If you wish, you may submit any written references by following the instructions at the end of this form. This input is primarily helpful in the absence of scores or referrals from giftedness professionals or other PG Retreat parents.

Click the submit button to send your application. Feel free to send any supporting documents or materials to application@pgretreat.com. We will respond to you shortly via phone or email. Thank you.

Save my progress and resume later | resume a previously saved form

Need assistance with this form?