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5 A A A U U U 8 , $ U M f U D A A A ( ( ( L A A ( ( ( ( mF U ( 0 M ( ( ( A ( ( ( M : SAMPLE WRITTEN NOTICE FOLLOWING AN IDENTIFICATION/EVALUATION PLANNING MEETING - ASSESSMENTS REQUIRED
Date
Name
Address
City, NJ ZIP CODE
Dear:
As the result of an identification and evaluation planning meeting held with you on (DATE), the (DISTRICT NAME); proposes to initiate an evaluation of your child for special education and related services. This decision was made as a result of a review of the current information and data available at the meeting. Therefore, the district proposes to conduct the following assessment(s) of your child and requests your consent to conduct the assessment(s).
Areas of Suspected Disability:
Assessment Procedures: Evaluators (by discipline):
_____ Standardized Test(s)
_______________________ _______________________
_______________________ _______________________
_____ Functional Assessment(s)
_______________________ _______________________
_______________________ _______________________
_____ Related (Therapy) Services
_______________________ _______________________
_______________________ _______________________
_____ Other (Please specify)
_______________________ _______________________
Other options (if any) that were discussed and the reasons they were rejected:
PROCEDURAL SAFEGUARDS STATEMENT:
As the parent of a student, or as an adult student, who has been determined not eligible for special education and related services, you have rights regarding the identification, evaluation, classification, the development of an IEP, placement and the provision of a free appropriate public education under the New Jersey Administrative Code for Special Education, N.J.A.C. 6A:14. A description of these rights, which are called procedural safeguards, is contained in the document, Parental Rights in Special Education (PRISE). This document is published by the New Jersey Department of Education.
A copy of PRISE is provided to you one time per year and upon referral for an initial evaluation, when you request a due process hearing or complaint investigation and when a disciplinary action that constitutes a change of placement is initiated. In addition you may request a copy by contacting (NAME OF DISTRICT PERSONNEL) at (PHONE NUMBER).
For help in understanding your rights, you may contact any of the following:
(NAME OF SCHOOL DISTRICT REPRESENTATIVE) (PHONE NUMBER)
Statewide Parent Advocacy Network (SPAN) 1-800-654-7726
Disability Rights New Jersey 1-800-922-7233 (In NJ only)
The New Jersey Department of Education through
the (NAME) County Office, (NAME OF COUNTY
SUPERVISOR OF CHILD STUDY) (PHONE NUMBER)
If you have any questions regarding this notice, please contact me.
Sincerely,
(NAME OF DISTRICT PERSONNEL)
(POSITION)
(PHONE NUMBER)
Parental Consent
Please complete the consent form below and return it to (NAME OF DISTRICT PERSONNEL) at (DISTRICT ADDRESS).
I have read the (DISTRICT NAME)'S proposal to evaluate my child, (NAME OF CHILD) and:
_____ I consent to the proposed assessments as listed in the attached notice. I understand that consent may be revoked at any time.
_____ I do not consent to the proposed assessments as listed in the attached notice.
Please note, in accordance with N.J.A.C. 6A:14-2.3(c), if you refuse to provide consent a district may request a due process hearing to obtain consent. Information regarding due process hearings can be found in the enclosed booklet, Parental Rights in Special Education.
A functional assessment includes assessment of academic performance and where appropriate, assessment of: behavior, language needs for LEP students, communication needs and the need for assistive technology. A functional assessment consists of an observation, interviews, record review, a review of interventions in general education and one or more informal measures.
Sample Notice - Revised 2013
Initial Evaluation - Assessment Required
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