IEP Team Amendments Page
Name
,
Birthdate
Date
Changes to the IEP dated
Changes to the IEP dated
Purpose of Meeting
____
(Initial) I agree to the contents of the amendment to the IEP dated
Parent/Guardian/Surrogate
Date
Parent/Guardian/Surrogate
Date
LEA Representative/Administrative Designee
Date
General Education Teacher
Date
Student
Date
Special Education Specialist
Date
Additional Participant/Title
Date
Additional Participant/Title
Date
Additional Participant/Title
Date
Additional Participant/Title
Date