Signature and Parent Consent (6B)
Page help
Name
IEP Date
IEP Meeting Participants
Parent/Guardian/Surrogate
Date
Parent/Guardian
Date
Student/Adult Student
Date
General Education Teacher
Date
LEA Representative/Admin. Designee
Date
Special Education Specialist
Date
Additional Participant/Title
Date
Additional Participant/Title
Date
Additional Participant/Title
Date
Additional Participant/Title
Date
Additional Participant/Title
Date
Additional Participant/Title
Date
Consent
____
I agree to all parts of the IEP
____
I agree with the IEP, with the exception of
____
I decline the offer of initiation of special education services
____
I understand that my child is NOT eligible for special education.
____
I understand that my child is NO LONGER eligible for special education.
As a means of improving services and results for your child did the school facilitate parent involvement?
As a means of improving services and results for your child did the school facilitate parent involvement?
As a means of improving services and results for your child did the school facilitate parent involvement?
Signature below is to authorize and approve the IEP.
Signature:
Date:
Relation
Relation
Relation
(if other, specify:)
Signature:
Date:
Relation
(if other, specify:)
Parent has received a copy of the Procedural Safeguards
Parent has received a copy of assessment report (if applicable)
Parent has received brochure and application for the Community Advisory Committee (CAC) for Special Education
Parent has received a free copy of the Individualized Education Plan (IEP). Parent has received a copy of the IEP.
Student enrolled in private school by their parents. Refer to Individual Service Plan, if appropriate.