Signatures and Parent Consent
Name   IEP Date
 
Graduation plan   
 

 
PARENT CONSENT (please initial areas of agreement)
 
____ I have received and understand the Procedural Safeguards.
 
____ I participated in the development of the IEP.
 
____ I agree with the IEP goals.
 
____ I agree with the recommended services.
 
____ 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.
 
      
 
____ The school district facilitated parent involvement as a means of improving services and results for your child.
 
      
 

 
____ I understand that my child is not eligible for special education.
 
____ I understand that my child no longer requires special education.
 

 
     


 

Relation  Date   Relation  Date
         
     


 

LEA Representative 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
         
     


 

Additional Participant/Title Date   Additional Participant/Title Date
 

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