Counselor Verification of Test Scores

Counselor Verification of Test Scores
COUNSELOR VERIFICATION OF TEST SCORES
Please complete this form if a copy of the student's test scores are not available.
STUDENT APPLICANT NAME
I hereby certify that the above applicant has tested in the 98th or 99th percentile on a nationally recognized achievement test or has an IQ of 130 or above, or meet the State of Hawaii Department of Education's selection criteria for participation in programs for gifted and talented students. The above applicant, in my judgment, is qualified for membership in the GEORGE B. CARTER SERTEENS CLUB OF HAWAII.
COUNSELOR SIGNATURE

Clear
DATE

MonthDayYear
Date
EMAIL
example@example.com
Should be Empty: