Medford Township Public Schools s1

MEDFORD TOWNSHIP PUBLIC SCHOOLS Medford, New Jersey THE CHALLENGE PROGRAM

Student Self-nomination Form Due Thursday, June 8th

Name: Elementary School: ______

I am completing the nomination form for the following course(s):

I have selected this/these course(s) and indicated my preference as options on my interest inventory.

Directions: Using the 9 point rating scale next to each item, pick the number from 1 to 9 that best describes you. Indicate your rating by circling the appropriate number. Do not place circles between two numbers. Answer all items. When rating each item, think about your self the following way:

How much does each point below describe you as a student?

Not at all like you?  Circle 1 Somewhat like you?Circle 4, 5, A little bit like you?Circle 2, 3 or 6 Very much like you?Circle 7, 8, or 9

Not at all Somewhat Very Much

1. Choosing difficult tasks or problems to work on… 1 2 3 4 5 6 7 8 9 2. Being interested in learning.……………………… 1 2 3 4 5 6 7 8 9 3. Carrying out tasks without a lot of supervision….. 1 2 3 4 5 6 7 8 9 4. Checking for and correcting my own errors……... 1 2 3 4 5 6 7 8 9 5. Solving problems in unique ways………………... 1 2 3 4 5 6 7 8 9 6. Having unusual and innovative ideas…………….. 1 2 3 4 5 6 7 8 9 7. Producing original or unusual products………….. 1 2 3 4 5 6 7 8 9 8. Choosing original methods………………………. 1 2 3 4 5 6 7 8 9 9. Maintaining intense interest in a subject…………. 1 2 3 4 5 6 7 8 9 10. Putting together ideas from different sources and using them in new situations…………………….. 1 2 3 4 5 6 7 8 9 Total Points:

Student Signature: ______

Parent Signature: ______