Iep Team Member Excusal - State Selpa Iep Template
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1STATE SELPA IEP TEMPLATE
IEP TEAM MEMBER EXCUSAL
Student Name
_____________________
Date of Birth ___/___/________
IEP Date ___/___/________
By mutual agreement between the parent/adult student, and designated representative of the local education agency, the
presence and participation of the Individual Education Program team member(s) identified below is/are not necessary and
has/have been excused from being present and participating in the meeting scheduled on _____/_____/_____ because (1) the
member’s area of the curriculum or related services is not being modified or discussed in the meeting or (2) the meeting involves
a modification to or discussion of the member’s area of curriculum or related services and the member submitted, in writing to
the parent and the IEP team, input into the development of the IEP prior to the meeting.
Individual Education Program Team Member(s)
Written input has been
submitted to the parent
Area Of Curriculum Or
and the IEP team prior to
Related Services is Not
the meeting regarding
The IEP team member is
Individual Education Program
Area Of Curriculum
Being Discussed Or
Area Of Curriculum Or
being mutually excused
Team Member(s)
Or Related Services
Modified
Related Services
from the IEP meeting
in whole
in part
in whole
in part
in whole
in part
in whole
in part
in whole
in part
in whole
in part
By mutual agreement the IEP team members identified above, have been excused from being present and participating in my
child’s IEP meeting.
Check the relationship to student, sign, and date below.
Signature of
Parent
Guardian
Surrogate: _______________________________________
Date: _____/_____/_____
Signature of
Parent
Guardian
Surrogate: _______________________________________
Date: _____/_____/_____
Signature of Adult Student (ages 18-21):
_______________________________________
Date: _____/_____/_____
Signature of Designated District Representative: _________________________________________
Date: _____/_____/_____
Title/Position: _____________________________________________________________________
“IDEA Section 614 (d) (1) (c) IEP TEAM ATTENDANCE- ‘(i) ATTENDANCE NOT NECESSARY – A member of the IEP team shall not
be required to attend an IEP meeting, in whole or in part, if the parent of a child with a disability and the local educational
agency agree that the attendance of such a member is not necessary because the member’s area of the curriculum or related
services is not being modified or discussed in the meeting, ‘(ii) EXCUSAL- A member of the IEP Team may be excused from
attending an IEP meeting, in whole or in part, when the meeting involves a modification to or discussion of the member’s area
of curriculum or related services, if—‘(I) the parent and the local educational agency consent to the excusal; and ‘(II) the
member submits, in writing to the parent and the IEP team, input into the development of the IEP prior to the meeting. ‘(iii)
WRITTEN AGREEMENT AND CONSENT REQUIRED- A parent’s agreement under clause (i) and consent under clause (ii) shall be
in writing.”
Revised 07/2013
Form 31
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