Prior Written Notice Of District'S Proposal/refusal Sat Team Recommendations: Multidisciplinary Evaluation Form

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PRIOR WRITTEN NOTICE OF DISTRICT’S PROPOSAL/REFUSAL

SAT Team Recommendations: Multidisciplinary Evaluation

Hancock County Schools

Student’s Full Name: ____________________________________________________

Date: ________________________

School: _______________________________________________________________

DOB: _________________________

Parent(s)/Guardian(s): __________________________________________________

Grade: _______________________

Address: _____________________________________________________________

WVEIS #: ____________________

City/State: ___________________________________________________________

Telephone: __________________

Dear ______________________________________,

As a result of:

_X_ 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 _____________________________,

___ other ____________________________________________________.

the district is providing you with written notice of the district’s _X_proposal / __ refusal of the following action(s) with regard to:

_X_ the educational evaluation or reevaluation of the student.

___ the identification of the student as having a disability.

___ the educational services and/or placement of the student.

___ the provision of a free appropriate public education (FAPE) to the student.

___ other _______________________________________________________. .

Specifically, the district is proposing the SAT team recommends a multidisciplinary educational evaluation to assess achievement and

cognitive ability of your child.

The district is proposing or refusing this action to identify academic strengths and weaknesses for educational planning and

programming.

The evaluation procedure(s), assessment(s), record(s) or report(s) the district used as a basis for the _X_ proposed/ _ refused action

are: (list here)____________________________________________________________.

Other options considered include: 1. provide no modifications or interventions 2. Monitor classroom performance..

The reasons the above options were rejected are: Instructional modifications and strategies have not enhanced student

performance in the classroom. The SAT requires further evaluation to determine strengths and weaknesses.

Other factors relevant to the district’s _X_ proposal / __ refusal are: Academic performance in class continues to decline.

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