State Selpa Iep Template - Individual Educational Program - Notice Of Meeting
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1STATE SELPA IEP TEMPLATE
INDIVIDUAL EDUCATIONAL PROGRAM - NOTICE OF MEETING
Initial
Annual
Triennial
Transition Planning
Pre-Expulsion
Interim
Other
_______________
Student Name _______________________________________
Date of Birth
___/___/________
Address ______________________________________________________________________________________________________
Dear_____________________________________
Today’s Date ____/____/________
An Individual Education Program (IEP) Meeting has been scheduled for the above student. Your participation is important in the
development of an appropriate education. The student could benefit from participation in the IEP Meeting and is invited to attend.
Secondary students age 15 or older should attend the IEP Team meeting as appropriate. You have the right to have other individuals
present who have knowledge or special expertise relating to the above student. If this is the initial IEP meeting and the student was
receiving services under Part C, through an IFSP you may request that the district invite the Part C Service Coordinator or other
representative. You are requested to attend this meeting as a participating member of the IEP team. The meeting is scheduled for:
Date
____/____/________
Time _____________________________________
School / Location _____________________________________
Room_____________________________________
We anticipate that the following members may also attend
Administrator/Designee
________________________________________________
Special Education Teacher
________________________________________________
General Education Teacher
________________________________________________
Student
________________________________________________
Psychologist
________________________________________________
Specialist (type) ________________________________
________________________________________________
NOTICE: If you wish to audio tape this meeting, you must provide 24 hour notice; we will also audio tape the meeting.
If you would like further information about your Procedural Safeguards or the purpose of this meeting, please call:
Name
______________________________________
Title __________________________________________
School / District
______________________________________
Phone__________________________________________
Please complete and sign this form, and return to __________________________________________________________________
Check the following items, as appropriate:
YES, I plan to attend the meeting
I do not plan to attend the meeting, but I am available by teleconference
I require assistance of an interpreter. (language) __________________________________________________________________
I request a different time and/or place. Please call me at home (____) ___________________ work (____) ___________________
I give my consent for the district to invite other agency personnel to attend the meeting if secondary transition is being addressed.
Signature _______________________________________________________
Date ___/___/______
Parent
Guardian
Surrogate
Adult Student
NO, I cannot attend the meeting, but hereby give my permission for the meeting to be held without me (CFR 300.322d). I understand
the IEP and related documents from this meeting will be provided to me for my signature, and I agree to return them in a timely manner.
NO, I cannot attend, but I will send ________________________________ as my representative to speak for me. I understand the IEP
and related documents from this meeting will be provided to me for my signature, and I agree to return them in a timely manner.
Signature _______________________________________________________
Date ___/___/______
Parent
Guardian
Surrogate
Adult Student
Revised 07/2013
Form 23A
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