IEP Summary
IEP Date   Student Name
 
Purpose: dated dated  
  See summary notes
 
Notifications
 
 
Notice has been provided to student/parent that completion of the requirements for graduation is projected at the end of the
 
  Upon graduation and issuance of a diploma, special education services from the district will be terminated and as a result, graduation will constitute a change of placement.
 
Parent Initials
Yes No  
_____ _____ 1. I have received and have been given an opportunity for a full explanation of the Procedural Safeguards.
_____ _____ 2. I agree with the Individualized Education Program (goals and objectives).
_____ _____ 3. I agree with the Special Education Program Placement and Services as described in this IEP.
_____ _____ 4. A continuum of program options has been discussed by IEP team.
_____ _____ 5. Promotion/high school graduation requirements were reviewed with parent and student including the California High School Exit Exam (CAHSEE).
_____ _____ 6. I agree with the Individual Transition Plan (16 years or older).
_____ _____ 7. Rights were reviewed with student age 17 and older.
_____ _____ 8. I agree my child does not meet the eligibility criteria for Special Education Services.
_____ _____ 9. I understand my child is no longer eligible for Special Education Services.
 
 
     


 

Parent/Guardian Date   Administrator/Designee Date
         
       


 

Parent/Guardian Date   Teacher Date
         
     


 

Student Date   Special Education Teacher Date
         
     


 

Psychologist Date   Speech and Language Specialist Date
         
     


 

Interpreter Date   Adapted Physical Education Teacher Date
         
     


 

Other Date   Other ____________________ Date
         
     


 

Other Date   Other ____________________ Date
 
PARENT NOT PRESENT. Attempts to contact the parents include documentation of:
 
Telephone calls Home visits Copies of correspondence Parent/teacher conference
 
Did the school district facilitate your involvement as a means of improving services and results for your child?
 
_____   If my child is or may become eligible for public benefits (Medi-Cal), I authorize the district to access Medi-Cal health insurance benefits for applicable services.
 
Dissenting Opinion Attached
 
 
Obsolete (these items print on the 2008-2009 form only)
 
Transitions:
 
Beginning at age 16 (or younger if determined appropriate), describe transition service needs of student related to courses of study:
 
 
Beginning at age 16 (or younger if determined appropriate), see attached Individual Transition Plan (ITP) dated Beginning at age 16 (or younger if determined appropriate), see attached Individual Transition Plan (ITP) dated  
 
On or before the student's 17th birthday, he/she has been advised of rights at age of majority (age 18)
 
Advised:   Date Date
  (by Whom)