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Purpose*
Purpose*
Purpose*
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Student's Name |
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Birthdate |
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Address (line 1) |
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Address (line 2) |
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City |
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State |
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Zip |
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Today's Date
Today's Date
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Dear
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An Individual Education Program (IEP) Meeting has been scheduled for the above student. Your participation is important in the development of an appropriate education. The student could benefit from participation in the IEP Meeting and is invited to attend. Secondary students age 15 or older should attend the IEP Team meeting as appropriate. You have the right to have other individuals present who have knowledge or special expertise relating to the above student. If this is the initial IEP meeting and the student was receiving services under Part C, through an IFSP you may request that the district invite the Part C Service Coordinator or other representative. You are requested to attend this meeting as a participating member of the IEP team. The meeting is scheduled for: |
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Date*
Date*
Date*
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Time |
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School/Location |
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Room |
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We anticipate that the following members may also attend: |
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Administrator/ Designee
Administrator/ Designee
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Other
Other
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Special Education Teacher
Special Education Teacher
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Other
Other
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General Education Teacher
General Education Teacher
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Other
Other
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Student |
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Other
Other
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Psychologist
Psychologist
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Other
Other
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Specialist
Specialist
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Other
Other
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NOTICE: If you wish to audio tape this meeting, you must provide 24 hour notice. We will also audio tape the meeting. |
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If you would like further information about your Procedural Safeguards or the purpose of this meeting, please call: |
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Name |
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Title |
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School/District |
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Phone |
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Please complete and sign this form, and return to:
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Check the following items, as appropriate: |
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I plan to attend the meeting |
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I do not plan to attend the meeting, but am available by teleconference |
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I require assistance of an interpreter. Language: _______________________________ |
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I request a different time and/or place.
Please call me at home (______) _________________ work (______) _________________
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I give my consent for the district to invite other agency personnel to attend the meeting if secondary transition is being addressed. |
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NO, I cannot attend the meeting, but hereby give my permission for the meeting to be held without me (CFR 300.322d). I understand the IEP and related documents from this meeting will be provided to me for my signature, and I agree to return them in a timely manner. |
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NO, I cannot attend, but I will send __________________________________________ as my representative to speak for me. I understand the IEP and related documents from this meeting will be provided to me for my signature, and I agree to return them in a timely manner. |
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