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 district’s 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]