Signature and Parent Consent (6B)
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  Incomplete Incomplete
 
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 agree with the IEP, with the exception of  
 
____ I decline the offer of initiation of special education services
 
____ 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 Relation Relation  (if other, specify:)      
           
  Signature:   Date:  
   
   
  Relation  (if other, specify:)      
 
As a means of improving services and results for your child did the school facilitate parent involvement?
 

 
Parent has received a copy of the Procedural Safeguards
 
Student enrolled in private school by their parents. Refer to Individual Service Plan, if appropriate.
 
Parent has received brochure and application for the Community Advisory Committee (CAC) for Special Education
 
Parent has received a free copy of the IEP.