IEP Form 6 – 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. No
Longer Eligible: If team determines child is no longer eligible for special
education, check the appropriate box.
5. Signature:
Have parent(s)/guardian/surrogate/adult student sign and date.
6. Public
Benefits: If parent agrees to authorize district access to health insurance
benefits provided by Medi-Cal, check box and have parent/guardian sign.
7. 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.
[Source: State SELPA IEP Manual, December, 2007]