The purpose of this mixed methods study was to examine the underrepresentation of twice-exceptional students in gifted programs. The study focused on the underrepresentation of twice-exceptional students in being recommended for gifted testing (Missett et al., 2016). The participants of the study encompassed kindergarten through fifth grade elementary school teachers within Georgia who teach in gifted programs, teachers of those with disabilities, and general education teachers. A mixed methods approach included a survey with demographic information and scenarios with student profiles. Respondents rated the likelihood the student would be recommended for gifted testing and why. The survey contained a rating scale and open- ended questions. The survey was done through social media. The qualitative and quantitative results were obtained from 213 participating teachers in the state of Georgia. After one-way ANOVA tests, the results suggested that the overall likelihood of students being referred for gifted testing were significantly different due to a teacher's number of years teaching, number of years involved in a gifted program, and certification category or teacher type. Students of general education teachers were more likely to receive a recommendation than students of teachers who teach students with disabilities. Regression results also demonstrated that teachers' number of years teaching and involvement in a gifted program had a significantly positive predictive relationship with the overall likelihood of students being referred for gifted testing. The longer a teacher teaches, and the number of years involved in a gifted program, the more likely the teacher will refer a student for gifted testing. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]