Parent/guardian Excusal Of An Individualized Education Program Team Member Form
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1PARENT/GUARDIAN EXCUSAL OF AN INDIVIDUALIZED EDUCATION PROGRAM TEAM MEMBER
DATE: _____________ STUDENT’S NAME: __________________________________STUDENT’S DATE OF BIRTH: ____________
Dear _______________________________________:
(Parent’s/Guardian’s Name)
An IEP Team meeting is scheduled for your child on __________________________.
We
met in person
spoke on the phone
exchanged e-mails
exchanged faxes
and agreed to the following:
Allowing team members to be excused from attending an IEP meeting is intended to provide additional flexibility to parents in
scheduling meetings. The presence and participation of the required Individualized Education Program (IEP) team member(s) identified
below is/are not necessary and has/have been excused from being present and participating in the meeting. The “team member” is
described in the regulations as, the general education teacher, special education teacher, LEA representative, and/or an individual who
can interpret the instructional implications of evaluation results, who may be a member of the team already identified.
Content area of excused member not discussed at the meeting
The school district and parent/guardian agree the following member(s) is/are not required to attend the IEP meeting
Yes
NA
in whole or in part because the individual’s area of curriculum, content or related service will not be discussed or
modified.
____________________________________________
___________________________________________
Name and Area
Name and Area
____________________________________________
___________________________________________
Name and Area
Name and Area
Content area of excused member discussed at the meeting
The school district and parent/guardian agree the following member(s) may be excused from attending the IEP meeting in whole
Yes
NA
or in part, when the meeting involves a modification to or discussion of the member’s area of the curriculum or related
services, if the member submits input into the IEP in writing to the parent and to the team prior to the meeting.
____________________________________________
___________________________________________
Name and Area
Name and Area
____________________________________________
___________________________________________
Name and Area
Name and Area
___________________________________________________
_________________________________________
Parent/Guardian Signature
Date
___________________________________________________
_________________________________________
Authorized School Personnel Signature
Date
If you have any questions or would like a copy of Explanation of Procedural Safeguards, please contact:
Name: _______________________________ Title: _______________________________________Phone: _____________________
Sincerely,
___________________________________________
(Signature)
Name: _____________________________________
ISBE 34-57H (4/08)
Title: _____________________________________
BASSC: Belleville Area Special Services Cooperative Phone: (618) 355-4700
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