FORMS 6A & 6B – SIGNATURE AND PARENT CONSENT

 

1.      IEP Meeting Participants: Have all meeting participants sign and date that they were in attendance. Make sure to include titles of each participant.

 

2.      Consent: Have the parent(s)/guardian/surrogate/adult student initial, if they agree in- whole or in-part to the IEP. If they agree only in-part, document the areas they are not in agreement with. Steps to resolve the disagreement should be documented on Form 7.

 

3.      Not Eligible: If team determines child is not eligible for special education, check the appropriate box.

 

4.      If the parent(s)/guardian/surrogate/adult student declines the initiation of special education and related services, check the box.

 

5.      No Longer Eligible: If team determines child is no longer eligible for special education, check the appropriate box.

 

6.      As a means of improving services and results for your child did the school facilitate parent involvement? When in the Future IEP be sure to uncheck the box prior to the IEP meeting. During the IEP meeting, check the appropriate box.  This is a required CASEMIS data field. One of the boxes must be checked.  Note: you need to ask this question annually, and the parent needs to check the box.  No response does not mean we forgot to ask. If the parent(s)/guardian/surrogate/adult student checks no, then the team needs to agree on a plan to address the issue in the coming year.

 

7.      Parent(s)/guardian/surrogate/adult student received a copy of the assessment report if applicable.  Check this box if the parent(s)/guardian/surrogate/adult student received a copy of the assessment report.

 

8.      Parent(s)/guardian/surrogate/adult student received a copy of the IEP.

 

9.      Signature: Have parent(s)/guardian/surrogate/adult student sign and date.

 

10.    Public Benefits: If parent agrees to authorize district access to health insurance benefits provided by Medi-Cal, check the appropriate Yes or No box and have parent/guardian sign.  Also indicate using the check box whether the parent(s)/guardian/surrogate/adult student have been given their written notification of protections to access Medi-Cal.

 

11.    Students Enrolled in Private Schools by Their Parents: If the student is enrolled in private school by his/her parent(s)/guardian/surrogate/adult student, check the box and develop a Services Plan, if appropriate.

 

 

Note: Form 6A is used by the District/LEA/SELPA with Medi-Cal signatures. Form 6B is used by the District/LEA/SELPA without Medi-Cal signatures.


Educational Benefit Reminder

 

 

-   Did all IEP Meeting participants sign and date, if required?

-   Do the parent(s)/guardian/surrogate/adult student consent to all components of the

IEP?

-   If not, are areas of agreement and/or disagreement clearly specified?

-   Are the next steps identified for reaching resolution, if appropriate?

-   Are all required notifications marked for compliance?

 

 

 

[Excerpted from the State SELPA IEP Manual, July, 2013]