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.