Student Name |
, |
DOB |
|
School |
|
|
|
|
|
|
|
|
|
The district and the parent/guardian of the student agree that the district has offered the student a free appropriate public education (FAPE) at the IEP meeting held on (see attached). Parents have declined the district’s offer of FAPE and instead have placed the student in the private school at their own expense. The parents agree that the district has no responsibility for the costs of the private school placement.
The Local Education Agency (LEA) will provide special education service(s) as outlined below for the student while enrolled in private school or until the proportionate share of Federal funds have been expended for the current school year.
|
|
|
|
|
Area of Need |
|
|
Present Level |
|
|
Annual Goal |
|
|
Personnel Responsible |
|
|
|
|
The parents understand in accordance with IDEA 2004, their rights to due process
do not apply in the private school setting.
|
|
Parent |
|
|
Date |
|
|
|
|
|
|
|
|
|
Administrator |
|
|
Date |
|
|
|
|
|
|
|
|
|
Other |
|
|
Date |
|
|
|
|
|
|
|
|
|
|
Next Annual Review Date |
|
|
Next Triennial Review Date |
|
|
|
|
|
|
|