Signature and Parent Consent
Name
IEP Date
IEP Meeting Participants
Parent
Date
Parent
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 OR I agree with the IEP, with the exception of:
____
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
Signature:
Date:
Relation
Student enrolled in private school by their parents. Refer to Individual Service Plan, if appropriate.
Student enrolled in private school by their parents. Refer to Individual Service Plan, if appropriate.