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 OR I agree with the IEP, with the exception of:
 
 
____ I understand that my child is NOT eligible for special education.
 
____ I understand that my child is NO LONGER eligible for special education.
 



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.