IEP Form – Signature and Parent Consent

 

1.            IEP Meeting Participants: Have all meeting participants sign and date that they were in attendance. Make sure to include titles of each participant.

 

2.            Consent: Have the parent initial, if they agree in-whole or in-part to the IEP. If they agree only in-part, document the areas they are not in agreement with. Steps to resolve the disagreement should be documented on Form 7.

 

3.            Not Eligible: If team determines child is not eligible for special education, check the appropriate box.

 

4.            If the parent declines the initiation of special education and related services, check the box.

 

5.            No Longer Eligible: If team determines child is no longer eligible for special education, check the appropriate box.

 

6.            Signature: Have parent(s)/guardian/surrogate/adult student sign and date.

 

7.            Public Benefits: If parent agrees to authorize district access to health insurance benefits provided by Medi-Cal, check box and have parent/guardian sign.

 

8.            Students Enrolled in Private Schools by Their Parents: If the student is enrolled in private school by his/her parent, check the box and develop a Services Plan, if appropriate.

 

   Educational Benefit Reminder  

o        Did all IEP Meeting participants sign and date, if required?

o        Do the parent(s) consent to all components of the IEP?

o        If not, are areas of agreement and/or disagreement clearly specified?

o        Are the next steps identified for reaching resolution, if appropriate?

 

 

[Excerpted from the State SELPA IEP Manual, July 2009. For the 2008-2009 form set.]