IEP 7 TEAM MEETING ADDENDUM PAGE
Name Birthdate Date

Addendum/Attachment to IEP?   To be attached to IEP dated To be attached to IEP dated
Note: For addendum, IEP Team MUST convene.
Purpose of Meeting
 
Notes
 

____ I agree to the contents of the addendum to the IEP dated
 
____ I have received and have been given an opportunity for a full explanation of the Procedural Safeguards.
 
       
 

 

  Parent/Guardian/Surrogate Date   Parent/Guardian/Surrogate Date
           
       
 

 

  LEA Representative Date   General Education Teacher Date
           
       
 

 

  IEP Chairperson/Administrative Designee Date   Special Education Specialist Date
           
       
 

 

  Student Date   Additional Participant/Title Date
           
       
 

 

  Additional Participant/Title Date   Additional Participant/Title Date
           
       
 

 

  Additional Participant/Title Date   Additional Participant/Title Date
 
Parent requested a copy of IEP in primary language: Parent requested a copy of IEP in primary language: