FORM 31 IEP TEAM MEMBER EXCUSAL FORM

 

This form is to be used when the LEA is requesting the parent or guardian to excuse a required IEP team member from an IEP in whole or in part. Separate columns and check boxes have been added to clearly identify the area of curriculum or related service not being discussed as well as the submission of written input provided to the parent/guardian/surrogate or adult student for the area of curriculum or related services of the missing IEP Team member.

 

 

 

1.      Student Name: Enter students full name.

 

2.      Date of Meeting: Enter the date of the meeting.

 

3.      Check the Box in Whole or in Part:   If the IEP team member is being excused for the entire meeting check in whole” and check in part if the team member is only being excused for part of the meeting.

 

4.      Individual Education Program Team Member(s): List the members that will be excused from the IEP team meeting in whole or in part.

 

5.      Area of Curriculum or Related Services: List the area of curriculum or related services that pertain the IEP team member being excused.

 

6.      Area of Curriculum or Related Services is Not Being Discussed: Check the column if the area of curriculum or related services is not being discussed at the IEP team meeting.

 

7.      Written Input has Been Submitted to the Parent and the IEP Team Prior to the Meeting Regarding Area of Curriculum or Related Services: If the area of curriculum or related services pertaining to the IEP team member is going to be discussed at the IEP team meeting, then IEP team member must submit  his/her in writing to the parent and the IEP team prior to the meeting.

 

8.      Parent/Guardian/Surrogate or Adult Student Signature: The parent/guardian/surrogate or adult student must sign a date this form and identify in the check box their relationship to the student  in order for the IEP team to be excused in whole or in part.

 

9.      Signature of Designated District Representative: The district representative must also sign and date the form.

 

 

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