Signature and Parent Consent
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Name
IEP Date
IEP Meeting Participants
Parent
Date
Parent
Date
LEA Representative/Admin. 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
Additional Participant/Title
Date
Additional Participant/Title
Date
Parent Consent
____
I agree to all parts of the IEP.
____
I understand that my child/I am is NOT eligible for special education.
____
I understand that my child is/I am NO LONGER eligible for special education.
____
I received a copy of procedural safeguards.
Signature below is to authorize and approve the IEP.
Signature:
Date:
Relation
Signature:
Date:
Relation
____
If my child is or may become eligible for public benefits (Medi-Cal), I authorize district to access Medi-Cal health insurance benefits for applicable services.
Parent Signature
Student enrolled in private school by their parents. Refer to Individual Service Plan, if appropriate.