FORM 27 PRIOR WRITTEN NOTICE

 

This form is provided to parents prior to the district initiating or refusing to change the identification, evaluation, educational or placement or provision of a free appropriate public education.

 

    Fill out student name and date of birth.

 

    If the district is proposing to do something, check the box Proposal to initiate or change and then check the appropriate box that applies to the situation that has required a Prior Written Notice.

 

    If the district is refusing a request made by the parent, check the corresponding box and then check the box that applies to the situation that has required a Prior Written Notice.

 

    Description of proposed or refused action: Briefly describe the proposed action or the action that the district is refusing to take.

 

    Reason(s) for proposed or refused action: Note the specific reasons why the district is refusing to take a proposed action or a refused action.

 

    Description of evaluation procedures, tests, records, or reports used in deciding to propose or refuse this action: Document the procedures that the district used in making the determination to propose or refuse an action.

 

    Description of other options considered and reasons for rejecting them: Document other options that were considered and the reasons for rejecting the options.

 

    Other factors relevant to the proposal or refusal: Document any other factors that were relevant to the districts decision to propose or refuse to do an action.

 

    Print name of district contact, position, phone and email address

 

 

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