Iep Revision Form - South Bend Community School Corporation Special Education Department Page 2

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Notice of Case Conference
South Bend Community Sch Corp
Date of Report:__________
Individual Education Program
Student:
STN:
Date of Birth: __________________
Age: _______
Current Grade:_________
Gender:_______
A date, time, and place for a Case Conference Committee meeting for the above student has been mutually agreed
Date:
Time:
Place:
Purpose(s) of the meeting:
_____________________________________________________________________________________
I understand that a parent of a student with a disability has protection under the procedural safeguards which are pro-
vided with this notice and that I can request a copy of the procedural safeguards at any time. The procedural safe-
guards document includes a list of resources to contact for assistance in understanding the provisions of Indiana spe-
cial education rules.
Invited Individuals
The following individuals will be invited to this meeting either because their attendance is required or because the public
agency has determined that they have knowledge or special expertise regarding the student:
Position
Name
Additional Title
Email
Student
Public Agency Rep
Parent
Teacher of Record
General Ed Teacher
Instructional Strategist
Page 1

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