Permission For Termination Of Special Education Services Due To Graduation With A Regular Diploma printable pdf download

Permission For Termination Of Special Education Services Due To Graduation With A Regular Diploma

South Bend Community School Corporation

Special Education Services

215 S. St. Joseph St, South Bend, IN 46601

Ph: 574.283.8130 Fax: 574.283.810

Permission For Termination Of Special Education Services

Due To Graduation With A Regular Diploma

Dear Parent/Guardian:

Name of Student: __________________________ Date of Birth: __________________

SBCSC ID#: ______________________________ STN#: _______________________

The Case Conference Committee has determined that the above student will graduate from high school with a

regular diploma. The Indiana Department of Education's Rules and Regulations for Special Education, Article 7,

defines this as a "Change in Placement" and requires written parent consent. Students who are 18 years of age

or older may grant consent for themselves.

I agree ____ disagree ____ to the above named student graduating with a regular diploma from high school. I

understand that the student will no longer be eligible for special education and related services from the South

Bend Community School Corporation following graduation because the student has met state and local

educational requirements.

___________________________________________

Signature of Parent or Student (if 18 or older)

___________________________________________

Address

___________________________________________

City

Zip Code

___________________________________________

Phone

___________________________________________

Date

Please give a copy of this form to the parent (or student if 18), the school and return the original to Special

Education Services.

8/18/12

Permission For Termination Of Special Education Services Due To Graduation With A Regular Diploma