Prior Written Notice Of District'S Proposal/refusal Form
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1PRIOR WRITTEN NOTICE OF DISTRICT’S PROPOSAL/REFUSAL
Post Secondary/College Entrance and/or DRS Eligibility
Hancock County Schools
Date _______________________
Student’s Full Name ____________________________________________
School ______________________________________________________
DOB _______________________
Parent(s)/Guardian(s) ___________________________________________
Grade: _____________________
Address: ______________________________________________________
WVEIS:_____________________
City/State: ____________________________________________________
Telephone:__________________
Dear _________________________________:
As a result of:
___ a Student Assistance Team (SAT) meeting conducted on ____________________,
___ an Eligibility Committee (EC) meeting conducted on ________________________,
___ an Individualized Education Program (IEP) Team meeting conducted on ______________________,
___ a disciplinary action occurring on _____________________________,
X other requirements for college entrance exams and/or DRS eligibility.
the district is X proposing or __refusing to initiate or change:
X
the educational evaluation or reevaluation of the student.
___ the identification of the student as having a disability.
___ the educational placement of the student.
___ the provision of a free appropriate public education (FAPE) to the student.
Specifically, the district is: proposing to complete an educational evaluation to assess academic strengths and______
weaknesses.
The district is proposing or refusing this action because: updated testing is required for college entrance exams
and/or eligibility for services from DRS.
The evaluation procedure(s), assessment(s), record(s) or report(s) the district used as a basis for the X _ proposed or
___refused action are: review of student’s records, assessments, and reports and IEP verify the need for this
evaluation.
Other options the district considered include: not evaluating the student.
The reasons the above options were rejected are: updated evaluation will assist in transition planning to meet post
secondary education and employment goals.
Other factors relevant to the district’s proposal X_ or ___refusal are: none noted.
Exceptional students and their parents have protections under the procedural safeguards. A copy of the Procedural
Safeguards Brochure and assistance in understanding the provisions of the procedural safeguards may be obtained
by contacting the Director of Special Education at 304 564-3411, as appropriate, the local Parent Educator Resource
Center at ___________________ and/or the West Virginia Department of Education, Office of Special Programs at
304.558.2696 or 1.800.642.8541.
Sincerely,
__________________________________________
Signature/Position
Date
West Virginia Department of Education
July 2013
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