Dear _____________________________:
(Parent)
The school district believes that ________________________ should be identified/should no longer be identified/requires a change in or modification of the service agreement.
The basis for the belief that the student is or is no longer a protected handicapped student is:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
The proposed change or modification in the service agreement is:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
The procedures and types of tests that will be used in the evaluation are:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
If you have any additional information or medical records which will assist in this evaluation, please forward them to me or call me at __________________ to discuss this information.
Parents have the right to review all relevant school records of the student, meet with appropriate school officials to discuss any and all issues relevant to the evaluation and accommodations of their child, and give or withhold their written consent to these evaluations.
Directions: Please check one of the options and sign the form.
_____ I give my permission to proceed with the evaluation and/or modifications of the service agreement.
_____ I do not give my permission to proceed with the evaluation and/or modification of the service agreement.
My reason for disapproval is: ________________________________________________________
_________________________________________________________________________________
_____ I request an informal conference to discuss the evaluation and/or modification of the service agreement.
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