Forms
I. SAMPLE LETTERS FROM PARENT TO THE SCHOOL
Letter from Parent to School Requesting Child's Educational Records *
Letter from Parent to School requesting an evaluation for special education eligibility and services
II. INTAKE FORMS - EdLaw CLIENTS
Special Education Case Client Information Form (Due Process Cases)
Initial Client Interview - Important Questions
III. IEP FORMS
Annotated Individualized Education Program "IEP" Form for School Age Students
Annotated Notice of Recommended Educational Placement Form
IV. EVALUATION FORMS
Annotated "Permission to Evaluate" - Consent Form (School Age)
Annotated Reevaluation Report - (School Age)
V. MEDIATION AND DUE PROCESS FORMS
Mediation Request Form (Important: See Further Instructions at Office of Dispute Resolution Website)
Due Process Complaint Notice (Important: See Further Instructions at Office of Dispute Resolution Website)
VI. OTHER
Bureau of Special Education Complaint Form and Information Packet (See Further Instructions at ODR Website)
Letter from Parent to School Requesting Child's Educational Records *
Note: Single space the inside addresses and the "Re" lines, instead of double-spacing as shown (website editing function wouldn't permit us to show addresses single spaced).
John and Mary Parent
[Street Address]
[State, Town and Zip Code]
[Phone number]
[Email address]
[NAME OF PRINCIPAL]
[NAME OF SCHOOL]
[STREET ADDRESS]
[TOWN, CITY, ZIP CODE]
RE: Request and Parental Consent for Student's Education Records
Child's Name
DOB: (fill in birthdate)
School Name and Grade: (fill in status)
Dear Mr., Ms., Dr. _____________:
I request a copy of all education records in the School District's possession that pertain to [name of student]. I make this request under the Family Educational Records and Privacy Act (FERPA), 34 C.F.R. Part 99, the Individuals with Disabilities Education Improvement Act (IDEA 2004), and its regulations, 34 C.F.R. Sections 300.501 and 300.610-627.
This request encompasses the identified education records no matter where they may be located, whether in the Central Administration Office, the Special Education Office, or any other department or office within the School District. As authorized by Section 300.616 of the IDEA 2004 regulations, kindly also provide me with a "list of the types and locations of the [requested] education records" that are "collected, maintained or used" by the School District.
This request includes any and all items that contain personally identifiable information about [first name of student] and [names of parents], whether those items name us as the parents, name our child, or refer to our child or us, as the parents, by social security number or by student identifier number.
This request includes, but is not limited to, the following items: progress reports, report cards, deficiency notices, correspondence to and from parents and others, awards, standardized test results, staff memos, interoffice memos, emails, letters, notes and comments of any kind, including notes of telephone calls, multi-disciplinary meetings and observations of child, attendance records, including notices of truancy, suspension and expulsion, requests for and notices of Section 504 and IEP meetings, medical and school health records, notes of psychologists, speech and language therapists, resource specialists and other personnel who have provided services to, evaluated or otherwise been involved in or responsible for the provision of a free appropriate education, class schedules, referrals for evaluations, evaluations and assessments, third-party reports or writings of any kind, notices of placement and statements of rights that were provided to parents, including notes from multi-disciplinary team meetings and observations of the child, all IEPs and any documents related to the IEPs, videos and audiotapes.
I will contact you by phone by [a date two days after letter will be received] to find out when the records will be ready for pick-up. Please contact me if you have any questions.
Thank you.
Sincerely,
Mr. or Mrs. Parent
cc: [Director of Special Education]
*Form for students age 17 and younger; certain restrictions apply under FERPA for students 18 and over. Contact our office if you would like more information.
Letter from Parent to School requesting an evaluation for special education eligibility and services
Note: Single space the inside addresses and the "Re" lines, instead of double-spacing as shown (website editing function wouldn't permit us to show addresses single spaced).
John and Mary Parent
[Street Address]
[State, Town and Zip Code]
[Phone number]
[Email address]
[NAME OF PRINCIPAL]
[NAME OF SCHOOL]
[STREET ADDRESS]
[TOWN, CITY, ZIP CODE]
RE: Request and Parental Consent for a Special Education Evaluation
Child's Name
DOB: (fill in birthdate)
School Name and Grade: (fill in status)
Dear Mr., Ms., Dr. _____________:
I request the school district to evaluate my child, [name of child], for special education eligibility and services.
I am concerned about my child's progress in school. [Briefly describe the problems that your child is experiencing. You can mention your own observations, such as "When I work with Lisa or her homework at night, I notice that she does not seem to be able to sound out the words." Or "my son seems to be very unhappy in school and tells me that he can't keep up in the math class." Or "Mrs. Smith, Mary's language arts teacher, tells me my daughter is falling behind in her classwork and has trouble paying attention in class."]
To help expedite the requested evaluation, please know that by signing this letter I hereby consent to any and all testing that needs to be done to evaluate my child's need for special education services.
If the district wants me to sign an additional form, I will do so promptly. However, it is my understanding that since this letter already gives full written parental consent for the evaluation, the district has sixty (60) calendar days from the date you receive this letter to complete the evaluation and provide us with a copy of your report. It is very important to us that the school evaluation and planning for [name of child] be completed in a timely way.
I will call you by [a date two days after letter will be received] to follow up on this request. If you have any questions about this request, you may call or email me.
Sincerely yours,
Parent
cc: [Director of Special Education]
II. CLIENT INTAKE FORMS
Special Education Case Client Questionnaire (Due Process Cases)
Your name:
Address:
Phone numbers:
Home: Work: Cell: Email address:
Child's name:
School name:
School address:
Principal's name:
Special education director's name:
Child's grade level:
Child’s weakest academic areas:
Child's strongest academic areas:
What do you think your child's level is in reading? Writing? Math
When did the school develop your child's first IEP or 504 plan?
What are the dates of all your child's IEPs or 504 plans?
What are your child's disabilities, according to the school?
What are your child's disabilities, according to you?
Have you ever filed a complaint with the Pennsylvania Department of Education or ever made a previous due process request? If so, give dates.
How many times have you or someone on your behalf visited your child's classroom during the last six months?
If you could wave a magic wand and whatever you wanted for your child's schooling would come true, without regard to money, time or the school district's opinion, what would you want for your child?
IDENTIFICATION AND EVALUATION
1. In your opinion, was the school slow to acknowledge your child's special needs? If so, when did you first point out the problems to the school and ask for an evaluation? And when did that evaluation occur?
2. When were the evaluations of your child done? Has the school reevaluated your child every three years, at least? When did the school share those results with you?
3. Did you pay for the evaluations of your child? Or did the school pay for the evaluations'?
4.. Did the school make available to you a copy of the evaluation report no later than five days prior to the date of the scheduled 504 meeting or case conference committee (CCC) meeting?
5. Did you ever request an independent educational evaluation? What was the school's response? When did you receive the school's response?
OTHER SERVICES
6. Did the school ever offer Extended School Year (ESY) services to your child? If so, do you believe that those services were adequate? Did you see regression in your child during the summers, whether ESY was offered or not?
7. How about occupational therapy, speech therapy, physical therapy?
DISCIPLINE
8. Was your child ever suspended or expelled? Did the school continue to provide education and services to your child during that period of suspension or expulsion?
9. Has your child been disciplined for behaviors that are tied to his/her disabilities? If so, describe the discipline administered and the alleged reason for it. Continue on back if necessary.
10. If your child has had behavioral problems, was a Functional Behavior Assessment (FBA) done? If so, was a Behavior Intervention Plan (BIP) implemented?
11. If your child has been suspended, did the school provide, subsequent to the suspension of your child, a written statement to the parent regarding the student's misconduct and action taken?
12. If your child was suspended or expelled, did the school conduct a manifestation determination hearing within 10 instructional days of deciding to change the student's placement for disciplinary reasons? Did the school inform the parent of the decision and inform the parent of his/her rights?
PROCEDURAL VIOLATIONS
13. At the IEP meetings or 504 meetings, have the following people been in attendance: one or more of the student's current teachers or, for a new student, a teacher licensed in the area of the suspected disability; and at least one member of the multidisciplinary evaluation team or some other person knowledgeable about the evaluation procedures used and familiar with the evaluation results if the student was evaluated for the first time?
14. When the school set the date and time of an IEP or 504 meeting, were you consulted about the setting of that date and time or were you told to show up or else?
15. Did the school offer any training to you as a parent on the areas of your child's disability? Or were you training the school on those?
16. Did the school conduct staff and teacher training in the areas of your child's disability?
17. Did your school provide you with a copy of the notice of procedural safeguards at the time of notification of a CCC meeting or 504 meeting?
18. Did your school share records about your child with outsiders without your written permission?
19. Have you ever requested an IEP meeting or a 504 conference and had your request ignored? When?
20. After a case conference committee meeting or 504 meeting, were you presented with an IEP or 504 plan within 10 business days?
21. Did you ever ask for a copy of the school's file pertaining to your child? If so, did you receive the file? Was it complete, to the best of your knowledge? How long after your request did you receive the file?
22. Did the school share all academic and disciplinary records with you as they were produced? Or did you find some new records that you had never seen before at the time you received a copy of the school's file pertaining to your child?
23. Did the school change the placement of your child (new school, new environment) without convening the case conference committee or a 504 meeting?
FAILURE TO FOLLOW IEP/504 Plan or DEVISE PROPER IEP/504 Plan
24. If your child was to be provided accommodations for testing, which were listed in his IEP or 504 plan, were those accommodations given to your child?
25. Did the school follow all provisions of the child's IEP or 504 plan? If not, what provisions did the school not follow?
26. Were the goals and objectives written in any IEPs actually measurable?
27. Were the methods that were supposed to be used to measure them actually used?
28. Were the methods that were supposed to be used to inform you about your child's progress actually used?
29. Were all your child's teachers, even substitute teachers, familiar with your child's IEP or 504 plan?
30. Did your school ever have an IEP in place that was more than one year old?
31. Were you presented with a copy of the draft IEP before the IEP meeting or was your first viewing of it at the meeting itself?
DENIAL OF FAPE
32. Was your child's school day shorter than other kids' school day?
33. Were the recommendations of your health care professionals or experts ignored when presented at the IEP meeting?
34. Was your child allowed to participate in extracurricular activities that were offered to their non-disabled peers?
35. If you have provided transportation to school for your child, has the school offered to reimburse you for the costs and mileage?
36. Do you believe the school failed to provided needed education and services to your child because of staffing problems or budgetary issues, rather than your child's needs?
37. Do you believe that your child should have been provided assistive technology (computers, electronic devices) but was not? If so, what kind of assistive technology would have benefited your child and why?
38. Did the school bar your expert or advocate from attending and participating in the IEP meeting?
39. Do you believe the school failed to allow you and your experts/advisers to participate meaningfully in the decisions made as to your child's education?
40. Was your child educated in the Least Restrictive Environment (LRE), meaning was the classroom, resource room, etc., the best learning environment for your child, based on your child's needs?
41. If we go to a due process hearing, do you want the hearing to be open (as in open to the public so that other school officials and your family and friends can attend) or do you want it to be closed (as in closed to anyone who's not a party and who is not testifying as a witness?
FOR OLDER STUDENTS ONLY
42. For older students, did the school provide a free appropriate public education to your child who is less than 22 years of age and has not received a regular high school diploma?
43. For older students, did the school provide written notice at an IEP meeting no later than the student's 17th birthday, that the rights currently afforded the parent will transfer to the student at the age of 18 unless a guardianship of the student has been obtained?
44. If your child is age 16 or older, was he or she invited to the IEP meeting?
45. If your child is age 16 or older, was a transition plan included in his/her IEP?
HOMEBOUND INSTRUCTION
46. Was your child receiving homebound instruction? If so, did the IEP Team meet every 60 instructional days during that time period?
POTENTIAL WITNESSES
47. Please list the name, address, phone number and what you would expect each witness to be able to address at a possible hearing in your case. Add more sheets if necessary.
Name:
Title or Role of person:
Address:
Phone number:
Testimony would concern:
48. Is there anyone at the school district currently or in the past whom you believe shares your views of who your child is and what your child needs?
Name:
Title or Role of person:
Address:
Phone number:
Testimony would concern:
Name:
Title or Role of person:
Address:
Phone number:
Testimony would concern:
Initial Client Interview - 20 Important Questions
1. Did you receive a copy of your rights or procedural safeguards at any time? Have you read it?
2. Have you ever filed a complaint with the Pennsylvania Department of Education or contacted that department concerning your child's schooling?
3. Have you ever been to mediation or any other type of formal meeting with the school district?
4. If your child has been classified by the school system as having a disability, do you agree with that diagnosis? Why or why not?
5. Do you know and understand your child's IQ? Are you familiar with the "bell curve?" What is your expectation overall foryour child? Do you anticipate your child will finish high school on a regular diploma track? Will he or she go to college?
6. What do you think your child's ability level is in reading? Writing? Math?
7. Is there anyone at the school district whom you believe shares your view of who your child is and what your child needs?
8. Does your child have an IEP in place now? If so, do you think the IEP in place is appropriate or not? If not, in what ways do you think it is deficient?
9. Have you organized and filed your child's school records in a binder?
10. If behavior is an issue:
a. What is the worst act of misbehavior your child has engaged in at school?
b. How frequent is your child's misbehavior?
c. Does your child misbehave at home?
d. Has your child ever hurt any individual by his or her misbehavior?
11. Have you visited your child's classroom or program during the last six months? If so, how many times? Has anyone other than yourself visited your child's classroom or program during the last six months?
12. Are you familiar with web resources for information on special education, the law, and your child's disability?
13. Were you satisfied with your child's program before this year?
14. Have you ever complained to anyone in the district administration, such as the superintendent or a school board member? If so, have you complained in writing?
15. Have you ever requested the school to provide a complete copy of your child's educational records?
16. Do you understand your child's current IEP? If not, what don't you understand?
17. Has your child's IEP team ever discussed "ESY," a behavior plan, assistive technology, transition planning, or interagency programming?
18. Have you reviewed your child's comprehensive school evaluation? Do you understand it? If not, what don't you understand?
19. Are you familiar with an Independent Educational Evaluation ("IEE")? Have you ever requested the school district to pay for an IEE?
20. If you could wave a magic wand and whatever you wanted for your child's schooling would come true without regard to money, time or the school district's opinion, what would you want for your child?
For more information on Pennsylvania law and practice affecting children with disabilities, call us now at 610.606.5006 or email us now !
Education law is virtually all we do.
Education Law Advocates, P.C. skillfully represents parents and their children in southeastern anc central Pennsylvania, including the communities of West Chester, Lower Merion, Coatesville, Paoli, Downingtown and Upper Darby, and throughout the Philadelphia metropolitant area, including Chester County, Montgomery County, Delaware County, Bucks County, Lancaster County, Berks County, Schuylkill County, Dauphin County and York County.
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