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 student’s 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]