Acadia Parish Dismissal Letter For Special Education Services Template
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ACADIA PARISH DISMISSAL LETTER FOR SPECIAL EDUCATION SERVICES – revised 4/10vjm
DATE OF DISMISSAL:______________________
STUDENT’S NAME:________________________________ SCHOOL DISMISSED FROM:______________________________
SERVICES BEING DISMISSED:
__Self-Contained
__Adapted P.E.
__OT __PT __Speech Therapy __Vision Services
__Gifted/Talented __Resource
__Counseling
__Homebound
__Assistive Tech
SPED TEACHER/SERVICE PROVIDER’S NAME:
_______________________________________________________
DOCUMENTATION FOR REASON CHECKED BELOW: ________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
DISMISSAL REASONS (CAN CHOOSE ONLY ONE):
__ Progress Indicates Service(s) Checked Above No Longer Needed
__ Dropped Out (use this reason if student cannot be located and/or is not attending school)
__ Health Prevents Continuation
__ Death
*__ High School Diploma
*__ Certificate of Achievement
*__ Reached 22nd Birthday
*__ Louisiana High School Equivalency Diploma (GED)
*__ Louisiana High School Equivalency Diploma (GED) and Industry Based Skill Certificate
*__ Industry Based Skill Certificate
*__ Locally Designed Skill Certificate
*__ Skills Completion Certificate (Options Program Completer)
*If one of these were chosen, you MUST fill out POST SCHOOL TRANSITION below:
Post School Transition:
1. Where do you plan to live after high school? (Choose one)
__Live with my parent(s)/family
__With friends
__On my own
__Other
__Agency supported: Supervised apartment
__Agency supported: Group Home
__ Agency supported: Adult nursing home
2. Do you plan to attend post-secondary school/training? (Choose one)
__Four year or two year University or College
__Community/Technical School
__Vocational/Technical School
__Do not plan to attend post-secondary school/training
__Other specialized training
__High school completion (Adult Basic Education, GED)
__Short-term education or employment training program (WIA, Job Corps, etc.)
3. What community recreation/leisure activities do you plan to participate in after high school? (Choose all that apply)
__Sports
__Church
__Life-long learning classes
__Volunteer
__Spending time with family/friends
__Other
4. Which of the adult agencies listed below do you plan to access for funding and/or services after high school? (Choose all that apply)
__Louisiana Rehabilitation Services
__Bureau of Community Supports and Services
__Office of Citizens with Developmental Disabilities
__Office of Mental Health
__Social Security Administration
__None of the above
If “NO” STOP HERE – If “YES” please answer #6 through #8.
5. Do you plan to work after high school? _____YES
_____NO
6. What do you think your work environment will be? (Choose one)
__In a company, business, or service with people with and without disabilities
__In the military
__In supported employment (paid work with services and wage support to the employer)
__Self-employed
__In your family’s business (e.g., farm, store, fishing, ranching, catering)
__In sheltered employment (where most workers have disabilities)
__Employed while in jail or prison
7. Work type:
__Competitively Employed
__Some other type of employment
8. In what career area does the student plan to work? (Choose one)
__Agricultural/Natural Resources
__Human Services
__Arts, Audio-Video Technology/Communication
__Information Technology
__Architecture/Construction
__Law/Public Safety
__Business/Administration
__Manufacturing
__Education/Training
__Government/Public Administration
__Finance
__Retail/Wholesale Sales/Services
__Health Science
__Scientific Research/Engineering
__Hospitality/Tourism
__ Transportation, Distribution, & Logistics Services
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