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      



Student enrolled in private school by their parents. Refer to Individual Service Plan, if appropriate.