Prior Written Notice Of District'S Refusal Ineligibility For Special Education Form
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1PRIOR WRITTEN NOTICE OF DISTRICT’S REFUSAL
Ineligibility for Special Education
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:
___ a Student Assistance Team (SAT) meeting conducted on ____________________,
X
_
_ 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 ___proposal / X refusal of the following action(s) with regard to:
___ the educational evaluation or reevaluation of the student.
X
_
_ 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 refusing to qualify your child for special education services.
The district is proposing or refusing this action because: Your child did not meet eligibility criteria for the specified exceptionality.
The evaluation procedure(s), assessment(s), record(s) or report(s) the district used as a basis for the ___proposed/ X refused action
are: see attached eligibility committee report and eligibility criteria checklist
Other options considered include: team recommendations, interventions, and other SAT data and documentation
The reasons the above options were rejected are: criteria not met
Other factors relevant to the district’s ___proposal / X refusal are: your child will be referred back to Student Assistance Team (SAT)
for further monitoring and interventions as needed
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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