IEP 7 TEAM MEETING ADDENDUM PAGE
Name
Birthdate
Date
Addendum/Attachment to IEP?
Yes
No
Yes
No
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
Y
N
Y
N
Parent requested a copy of IEP in primary language:
Parent requested a copy of IEP in primary language: