Signature and Parent Consent (6A)
Page help
Name
IEP Date
IEP Meeting Participants
Parent/Guardian
Date
Parent/Guardian
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?
As a means of improving services and results for your child did the school facilitate parent involvement?
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
Parent has received a copy of assessment report (if applicable)
If my child is or may become eligible for public benefits (Medi-Cal), I authorize district to access Medi-Cal health insurance benefits for applicable services.
Parent Signature
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.