Resolution Meeting Form - Exceptional Children
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1NORTH CAROLINA DEPARTMENT OF PUBLIC INSTRUCTION
Exceptional Children Division
SPECIAL EDUCATION RESOLUTION MEETING
RESOLUTION MEETING FORM
OAH Case #___________
Child’s Name____________________________________
Petitioner(s): ____________________________________________________________
LEA: __________________________________________________________________
Date of Resolution meeting(s):__________ Location:__________________________
_____Expedited Due Process Hearing (check ONLY if associated with an expedited hearing)
CHECK ONE BELOW:
____ Parent agrees to attend a resolution meeting _____with attorney ____without attorney
____ Both LEA and parent agree to waive a resolution meeting Parent’s and LEA
representative’s signatures must be provided below.
____ Both LEA and parent agree to participate in mediation. Parent’s and LEA
representative’s signatures must be provided below. LEA must complete the form
and fax a copy of this document to EC Division at (919-807-3755) to schedule
mediation. **Incomplete form may delay the mediation process**
____ Parent refuses to participate in resolution meeting. LEA must document efforts to get
parent’s participation.
LEA Representative’s Signature: _______________________________Date:____________
Parent(s) Signature(s):_______________________________________Date:_____________
Please fill out the contact information for each party (parent, LEA representative or
attorney); this information will be used to set up the mediation meeting
Parent/Guardian’s contact information
LEA Representative contact information
Name/Title:____________________________
Name/Title:___________________________
Email:_____________________________
Email:_______________________________
Phone Number:______________________
Phone Number:_______________________
The EC Director should fax signed copies of this document as soon as both
parties have signed it. Fax to the attention of:
NCDPI-EC Due Process Coordinator at (919) 807-3755 and
Kim Hausen, Office of Administrative Hearings at (919) 431-3100.
7/1/15
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