Form M-3 - Agreement To Extend The Time Limit To Complete The Evaluation Of A Child Suspected Of Having A Specific Learning Disability
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1AGREEMENT TO EXTEND THE TIME LIMIT TO
COMPLETE THE EVALUATION OF A CHILD SUSPECTED
OF HAVING A SPECIFIC LEARNING DISABILITY (
M-3 )
CESA 7 _____________________________________
SCHOOL DISTRICT
[If you need this notice in a different language or communicated in a different way, or have
questions about this notice, please contact ______________________ at _____________________]
Dear_______________________________________________
Date ____________________
As you know school district staff are in the process of evaluating your child _______________________
to determine whether he / she has a specific learning disability and needs special education services.
School district staff assigned to your child’s individualized education program (IEP) team believe that
additional time is needed to complete this evaluation. On _________________ we [met or spoke on the
phone or exchanged emails] and agreed that this evaluation will be completed by _________________.
The reason(s) for extending the evaluation are:
)
(month/day/year
Other options, if any, related to the above action which were considered and the reason(s) they were
rejected, including a description of any other relevant factors include:
□
None
Your agreement to the above must be in writing.
Sincerely,
_____________________________________________________
Name and Title of District Contact Person
------------------------------------------------------------------------------------------------------------------------------
(Please sign, date and return one copy of this agreement to the school district.)
I agree to the extension as described above for completing the evaluation on my child and understand that
my agreement is voluntary.
_____________________________________________
__________________
Signature of parent or legal guardian or adult student
Date
You and your child have protection under the procedural safeguards (rights) of special education law.
The school district must provide you with a copy of your procedural safeguards once a year. Enclosed is
a copy or earlier this year you received a copy of your procedural safeguard rights in a brochure about
parent and child rights. If you would like another copy of this brochure, please contact the district at the
telephone number above. In addition to district staff, you may also contact ______________________ at
____________________ if you have questions about your rights.
10/06
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