IEP Amendment(s)/Addendum (8)
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Student Name     Date of Birth Amendment Date
 

 
     
  Purpose of Meeting Purpose of Meeting     
 
  Changes to the IEP dated Changes to the IEP dated    
 
   
 

 
_____ I agree to the contents of the amendment to the IEP dated  

         


 

Parent/Guardian/Surrogate/Adult Student Date   Parent Date
         


 

Student/Adult Student Date   General Education Teacher Date
         


 

LEA Rep./Admin. Designee Date   Special Education Specialist Date
         


 

Additional Participant / Title Date   Additional Participant / Title Date
         


 

Additional Participant / Title Date   Additional Participant / Title Date