Individual Service (s) Plan For Voluntarily Enrolled Private School Students (continued)
(This form can generate more than one printed page)
  Area(s) of Need   Annual Goals and Benchmarks / Short-Term Objectives  
 
 
  Parents will be informed of progress
 
  How?
 
  How disability affects involvement and progress in general curriculum: How disability affects involvement and progress in general curriculum:  
 
 
  Student will participate with non disabled children in the general education for: Student will participate with non disabled children in the general education for:
 
  District Personnel Responsible for implementation of Individual Service(s) Plan: District Personnel Responsible for implementation of Individual Service(s) Plan:
 
  Team meeting notes Team meeting notes  
 
 

 
  Parents acknowledge that they have voluntarily chosen to place their child in private school. The parents also understand in accordance with the IDEA 97 and NCCSE Policy #19 that their right to a Free Appropriate Public Education (FAPE) does not apply in the private school setting. Parents further acknowledge that they have been informed that upon contacting their District of Residence and expressing an interest in enrolling their child in a public school placement, the District will schedule and hold an IEP team meeting and make an offer of FAPE.
 
 
   (Parent Initials)  

 
       




Parent/Guardian/Surrogate Print Name Signature Date
 




District Administrator/Designee Print Name Signature Date
 




Special Ed. Teacher/Representative Print Name Signature Date
 




General Ed. Teacher/Representative Print Name Signature Date
 




Additional Participant/Title Print Name Signature Date
 




Additional Participant/Title Print Name Signature Date
 




Additional Participant/Title Print Name Signature Date