PRIOR NOTICE ABOUT EVALUATION & CONSENT FOR …
|PRIOR WRITTEN NOTICE & CONSENT FOR EVALUATION 300.9 AND 300.300 AND 300.503 |
|Dear _________________________________, |
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|Your consent and assistance are requested to determine if your child has a disability, or continues to have a disability, requiring special education services. |
|The school is proposing the following: 300.503(b)(2) |( Based on a review of existing information, no additional evaluation data are |
|( To evaluate your child for special education eligibility. 300.300(a) |needed to determine if your child is or continues to be eligible for special |
|( To reevaluate your child for special education eligibility. 300.300(c) |education services or to determine your child’s educational needs. 300.305(a) |
|Areas to be evaluated: |Reason: 300.305(d)(1)(i) |
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| |If you disagree, you may request an assessment. 300.305(d)(1)(ii) |
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|Reason: 300.305(d)(1)(i) | |
|This proposal is based on the following evaluation procedures, tests, records or reports: 300.503(b)(3) |
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|Other options considered and reasons(s) rejected were: 300.503(b)(6) |
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|Any other factors considered by the team: 300.503(b)(7) |
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|Sincerely, __________________________________________ ________________ |
|Name/Title Phone |
|Parents of a child with a disability have protection under the procedural safeguards. For a copy of your procedural safeguards or assistance in understanding this |
|information, please contact the person named above. 300.503(b)(4) |
|Consent for Special Education Evaluation |
|We request your consent because: |
|( This is an initial evaluation and will be used to determine whether your child is a child with a disability and to determine special education needs. 300.300(a) |
|( This is a reevaluation and will be used to decide your child’s continued eligibility and/or education needs. 300.300(c) |
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|( I give my consent for the evaluation or re-evaluation. I understand my consent is voluntary and may be revoked for any evaluation or reevaluation that has not yet|
|been conducted. 300.9(a),(b),(c),(1) and (2) |
|( I refuse consent for the evaluation. |
|( I agree that no additional evaluation data are needed. |
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|______________________________________________________ _______________ |
|Signature (Parent/Guardian/ESP) Date |
( Date consent received by District/Administrative Unit: _________________
( For initial evaluations, a copy of the Notice of Procedural Safeguards has been given to the parents.
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