IEP Form – 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.
If the parent declines
the initiation of special education and related services, check the box.
5.
No Longer Eligible: If team determines child is no
longer eligible for special education, check the appropriate box.
6.
Signature: Have parent(s)/guardian/surrogate/adult
student sign and date.
7.
Public Benefits: If parent agrees to authorize district
access to health insurance benefits provided by Medi-Cal,
check box and have parent/guardian sign.
8.
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.
Educational Benefit Reminder
o
Did all IEP
Meeting participants sign and date, if required?
o
Do the
parent(s) consent to all components of the IEP?
o
If not, are
areas of agreement and/or disagreement clearly specified?
o
Are the
next steps identified for reaching resolution, if appropriate?