Notice Of Ineligibility Template printable pdf download

Notice Of Ineligibility Template

Case Conference Committee Report

Student Name: ____________________________ STN: _____________________ DOB: _____________

Notice of Ineligibility

I understand that the case conference committee has determined that my child does not have a

disability that adversely affects his or her educational performance.

As the parent, I have a right to contest the agency’s decision by requesting mediation (511 IAC 7-

45-2) and/or a due process hearing (511 IAC 7-45-3). A parent of a student with a disability has

protection under the procedural safeguards which will be provided to me upon request. The

procedural safeguards document includes a list of resources to contact for assistance in

understanding the provisions of Indiana special education rules.

I have been presented with written notice which contains:

(1) A description of the action refused by the public agency;

(2) An explanation of why the public agency refused to take the action;

(3) A description of each evaluation, procedure, assessment, record, or report the agency

used as a basis for the refused action;

(4)A description of other options that the case conference committee considered and the

reasons why those options were rejected; and

(5) A description of other factors relevant to the agency’s refusal.

As the parent, I have a right to contest the agency’s decision by requesting mediation (511 IAC 7-

45-2) and/or a due process hearing (511 IAC 7-45-3). A parent of a student with a disability has

protection under the procedural safeguards which will be provided to me upon request. The

procedural safeguards document includes a list of resources to contact for assistance in

understanding the provisions of Indiana special education rules.

__________________________________________

_____________________________

Parent/Guardian Signature

Date

Notice Of Ineligibility Template