4-5 Permission to GATE Screening Form

1
Choose your student's school to find the screening date* This field is required.Each elementary school is being screened on specific dates with a make-up date scheduled for a later time. View the full schedule here: https://www.tusd.org/educational-services/gate
Adams Monday, November 17
Anza Wednesday, November 19
Arlington Wednesday, November 12
Arnold Wednesday, November 12
Carr Monday, November 17
Edison Tuesday, November 18
Fern Wednesday, November 12
Hickory Wednesday, November 12
Lincoln Thursday, November 13
Riviera Tuesday, November 18
Seaside Friday, November 14
Torrance Thursday, November 13
Towers Wednesday, November 19
Victor Monday, November 17
Walteria Tuesday, November 18
Wood Thursday, November 13
Yukon Tuesday, November 18
2
Student's Full NamePlease type your student's name as (Last Name, First Name) as it appears on your student's registration/report card.
First Name
Last Name
3
Student ID Number* This field is required.Please enter your student's school ID number as it appears on their report card or student ID.
Student ID
4
Student's Date of BirthPlease enter your student's date of birth.
Student's birth date
Year
Month
Day
5
Student's TeacherPlease enter just the last name of your student's teacher.
Teacher Name
6
Parent Name* This field is required.Please list your full name as it appears in our records.
First Name
Last Name
7
Parent Email* This field is required.Please list your full email address.
example@example.com
8
9
10
E-Signature* This field is required.By signing below you certify that you wish your student to be screened for the TUSD GATE program. You will receive an email copy of your submission. All student sign-ups will be verified against eligibility. Those who have been screened twice or are already GATE will not participate in this screening. Additional information is available at https://www.tusd.org/educational-services/gate.
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