Written Notice to Parent When Parent Revokes Consent to
Special Education and Related Services (28)


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  Student:    
     

 
 
Letter from parents dated Letter from parents dated
 
Letter received by district on Letter received by district on
 
Services to be discontinued on Services to be discontinued on
 
First school day thereafter First school day thereafter
 
Proposed exit meeting date with parents Proposed exit meeting date with parents
 
Exit meeting: Contact name
 
Exit meeting: Contact information
 
   Edit text of letter here:
 
 
 

  This information was used for the previous notice letter (before 7.2012):  
     
  Re: Written Notice Regarding Revocation of Special Education and Related Services  
     
  Dear    ,  
     
  At the IEP meeting on At the IEP meeting on      you advised the      
  School District that it was your intent to revoke consent in writing for the continued provision of special education and related services to your child. At the IEP meeting, the school district staff outlined the special education program and services that would be provided to your child. If you revoke your consent to the continued provision of special education and related services, you will be giving up your right and your child's right to these services and your child will not be considered a child with a disability. The district is taking this action after review of your written statement.

State and federal law and regulations provide protections and procedural safeguards for parents of students with disabilities. A statement of those protections and procedural safeguards is enclosed with this Prior Written Notice. By your revocation of consent for your child to receive special education and related services, these protections and procedural safeguards no longer are applicable to your child. The services and modifications that were agreed to in your child's most current IEP will no longer be available to him/her. Your child will not have any of the procedural safeguards available to students with disabilities in the event of any disciplinary action.

If you wish assistance in understanding the protections and safeguards, you may contact the special education teacher at your student's school or me.

If you wish to have your child considered for special education and related services in the future put your request in writing to the district for an assessment. If you need assistance with this process, contact the district and staff will be happy to assist you.
 
     
  We have appreciated the opportunity to provide     with the special education and related services that the District believed were necessary for your child.  
     
  Sincerely,  
     
     
  Enclosure: Procedural Safeguards Notice