IEP Team Amendments Page
Name , Birthdate Date

Changes to the IEP dated Changes to the IEP dated
Purpose of Meeting
 

____ (Initial) I agree to the contents of the amendment to the IEP dated
 
       
 

 

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

           
           
 

 

  LEA Representative/Administrative 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