Permission To Invite Outside Agency Template

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PERMISSION TO INVITE OUTSIDE AGENCY
Hancock County Schools
Student’s Full Name _____________________________________
Date ____________________________
School _______________________________________________
DOB __________WVEIS # __________
Parent(s)/Guardian(s) ____________________________________
Phone __________________________
Mailing Address _____________________________________________________________________________
Dear Parent(s)/Guardian(s) and Student,
As you prepare to transition to post-secondary goals such as college, vocational school, the work force, or adult
agency participation, there are many supports available to you to assist with these transitions. Community
agencies may provide support and services during this vital time. We request your permission to invite those
agencies indicated below to any and all of the upcoming IEP, eligibility, and/or other meetings where transition
issues will be discussed.
This consent will serve as notice that the following agencies may be invited to attend all meetings unless
otherwise requested in writing by the parent(s)/guardian(s) and student.
Sincerely,
_____________________________________________________________________________
Name/Position/Phone Number
Parent(s): Please return this form within 5 days. A copy will be provided for your records.
AGENCY(IES) INVITED (check all that apply):
____
Division of Rehabilitation Services (Vocational Rehabilitation)
____
Healthways
____
Hancock County Opportunity Center (HCOC)
____
Hancock County Sheltered Workshop/Hancock County Laundry (HCSW)
____
Wellsprings
____
Family Connections
____
Department of Health and Human Services (DHHR)
____
Other ____________________________________________________________________________
STUDENT RESPONSE (required at age 16)
PARENT RESPONSE (check one)
____
I give permission for the above agency(ies)
____
I give permission for the above agency(ies)
to be invited to meetings when transition is
to be invited to meetings when transition is
being discussed/considered.
being discussed/considered.
____
I do not wish to have the following agencies
____
I do not wish to have the following agencies
invited: (list) ________________________
invited: (list) _________________________
_________________________________________
__________________________________________
Student Signature
Date
Parent Signature
Date
Note: Permission to invite outside agencies may be revoked at any time through written request by parent(s)/guardian(s), and/or
student.

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