District-asfdEvaluation Ch 15(22 PaCode Ch 15)
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Basic Education Circulars (Pennsylvania Code) Sample Notice of District-Initiated Evaluation as a Protected Handicapped StudentAnnual Notice to Parents Attachment to Basic Education Circular SUBJECT: Implementation of Cha pter 15 22 Pa. Code Chapter 15 DATE OF ISSUE: July 1, 1999 DATE OF REVIEW: June 2009 Dear _____________________________: (Parent) The school district believes that ________________________ should be identified as a protected handicapped student /should no longer be identified/re quires a change in or modification of the service agreement. The basis for the belief that the student is or is no longer a protected handicapped student is: ___________________________________ ___________________________________ ____________________________________ The proposed change or modification in the service agreement is: ___________________________________ ___________________________________ ____________________________________ The procedures and types of tests that will be used in the evaluation are: ___________________________________ ___________________________________ ___________________________________ ____________________________________ If you have any additional information or medical records which will assist in this evaluation, please forward them to me or call me at ____ ______________ to discuss t his informati on. Parents have the right to review all relevant school records of the student, meet with appropriate school officials to discuss any and all issues relevant to the evaluation and accommodations of their child, and give or withhold their written consent to these evaluations. Directions: Please check one of the options and sign the form. _____ I give my permission to pr oceed with the e valuation and/or m odifications of t he service agreement. _____ I do not gi ve my permissi on to proceed wit h the evaluation and/ or modificati on of the
Transcript of District-asfdEvaluation Ch 15(22 PaCode Ch 15)
Basic Education Circulars (Pennsylvania Code)
Sample Notice of District-Initiated Evaluation as a Protected
Handicapped StudentAnnual Notice to Parents
Attachment to Basic Education Circular
SUBJECT: Implementation of Chapter 15
22 Pa. Code Chapter 15
DATE OF ISSUE: July 1, 1999
DATE OF REVIEW: June 2009
Dear _____________________________:
(Parent)
The school district believes that ________________________ should be identified as a protectedhandicapped student /should no longer be identified/requires a change in or modification of the
service agreement.
The basis for the belief that the student is or is no longer a protected handicapped student is:
___________________________________________________________________________ ___________________________________________________________________________
___________________________________________________________________________
The proposed change or modification in the service agreement is:
___________________________________________________________________________ ___________________________________________________________________________
___________________________________________________________________________
The procedures and types of tests that will be used in the evaluation are:
___________________________________________________________________________
___________________________________________________________________________ ___________________________________________________________________________
___________________________________________________________________________
If you have any additional information or medical records which will assist in this evaluation,
please forward them to me or call me at __________________ to discuss this information.
Parents have the right to review all relevant school records of the student, meet with appropriateschool officials to discuss any and all issues relevant to the evaluation and accommodations of
their child, and give or withhold their written consent to these evaluations.
Directions: Please check one of the options and sign the form.
_____ I give my permission to proceed with the evaluation and/or modifications of the service
agreement.
_____ I do not give my permission to proceed with the evaluation and/or modification of the
service agreement.
My reason for disapproval is:
________________________________________________________
______________________________________________________________________________ _
_____ I request an informal conference to discuss the evaluation and/or modification of the
service agreement.
______________________ ______________________
Parent(s) Signature Date
Bureau of Special Education
Pennsylvania Department of Education
333 Market Street
Harrisburg, PA 17126-0333
Telephone: (717) 783-6134
