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| Date (mm/dd/yyyy): __________ | Written Notice Number: ___________________ |
| To: __________________________________________ | | |
| From: ________________________________________ | | |
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| I am inviting you to attend a meeting to discuss the educational needs of: |
__________________________________________ Student's Full Name | _______________ Birthdate (mm/dd/yyyy) | |
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| PURPOSE FOR MEETING (Check all which apply): | | |
q Decide if a child has a suspected disability | q Discuss transition from early childhood to school-age programs |
q Develop an evaluation plan | q Discuss transition from school-age to post secondary programs/activities |
| q Decide on eligibility for services as a child with a disability | q Discuss disciplinary matters |
| q Develop, review, &/or revise the student's IEP | q At your request to discuss: |
| q Decide on need to Reevaluate | q Other: |
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| This conference will be scheduled as a (check one): | | |
q Face to face meeting | q Video Conference | q Phone Conference/Conference Call |
| Date (mm/dd/yyyy): _______________ | Time: __________ | Location: _______________ |
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| Other persons invited to attend this meeting include: |
| q Regular Education Teacher | q Student | q Other ___________________ ___________________ |
| q Speech & Language Pathologist | q School Psychologist |
| q Special Education Teacher | q District Representative |
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| Please bring any data, including formal or informal test results, work samples, etc., to the meeting. Bring people who know or have special expertise regarding your child or who will assist you at the meeting. |
| If you want to schedule the conference at a different time, date, or location, or schedule a different type of meeting, or if you need an interpreter, contact: _______________________________ at ________________. |
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| ------------------------------------------------------------------------------------ Cut Here -------------------------------------------------------------------------------- |
Call or complete & return to the student's school. |
| Student Name _________________________________ | Birthdate _______________ |
| q I will attend/participate | q I would like the location of the meeting changed. |
| q Another/Others will accompany me (optional) | q I would like to change the type of meeting to (face to face, video/ teleconference) |
| q I will not attend/participate |
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| I need this meeting rescheduled for the following suggested date & time: ______________________________ |
| Do you need bilingual or sign language interpreter? | q Yes q No | |
If Yes, specify language/mode of communication _________________________________________________ |
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| Parent Signature: ______________________________ | Date: _______________ | |
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| Effective: 2/1/07 | | |
| PR-02 | | |
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