Appointment Of Educational Surrogate Parent printable pdf download

Appointment Of Educational Surrogate Parent

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

APPOINTMENT OF EDUCATIONAL SURROGATE PARENT

STUDENT

APPOINTEE

Name:

________________________

Name:

________________________

D.O.B.:

________________________

Address:

________________________

Address:

________________________

Phone:

________________________

Disability:

________________________

Date:

________________________

School:

________________________

Dear ______________________________:

If the student is a ward of the state or the whereabouts of the parent are unknown, federal and

state law require the appointment of an educational surrogate parent. An educational surrogate

parent must be appointed for any student with a disability or a student referred for an evaluation

to determine eligibility for special education services. The requirement does not apply to a

student whose parents are available but choose not to participate in their child’s evaluation

and/or special education services. An educational surrogate parent may not be employed by a

public or private agency involved in the education and care of a student.

The above named student is in need of an educational surrogate parent and the South Bend

Community School Corporation is appointing you to that important position. In this capacity you

possess all of the rights and responsibilities of a parent in matters relating to this student’s

special education and related services needs.

If you have any questions, please call me.

Cordially,

Director of Special Education

Copies to: parent, cum, TOR and original to Special Ed. Dept.

Revised 1/27/12

Appointment Of Educational Surrogate Parent