Title
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Date (mm/dd/yyyy) *
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Written Notice Number *
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To *
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From *
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I am inviting you to attend a meeting to discuss the educational needs of
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Student's Full Name *
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Date of Birth (mm/dd/yyyy) *
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PURPOSE FOR MEETING (check all which apply) *
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If At your request to discuss, explain (if not applicable type NA) *
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If Other, explain (if not applicable type NA) *
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This conference will be scheduled as a (check one) *
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Conference Date & Time *
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Other persons invited to attend this meeting include (if not applicable select NA) *
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If Other, please explain (if not applicable type NA) *
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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 not applicable type NA) *
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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 NAME, NUMBER (if not applicable type NA) *
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Call or Complete & Return to the Student's School.
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Name of Student *
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Birthdate (mm/dd/yyyy) *
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Select from the Following *
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If I would like to change the type of meeting to, select (if not applicable select NA) *
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I need this meeting rescheduled for the following suggested date & time (mm/dd/yyyy & hh:mm AM/PM) (If not applicable type NA) *
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I need a bilingual or sign language interpreter *
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If Yes, specify language/mode of communication (if not applicable type NA) *
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Parent Signature *
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Date of Signature (mm/dd/yyyy) *
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Effective date: 2/1/07
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