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AEA IEP DOCUMENTATION GUIDE: Prior Written Notice and Consents

Prior Written Notice of a Proposed or Refused Action (PWN)

Overview

Prior written notice must be given to the parents of a child with a disability a reasonable time before the public agency (LEA or AEA)

  • Proposes to initiate or change the identification, evaluation, or educational placement of the child or the provision of  FAPE to the child; or 
  • Refuses to initiate or change the identification, evaluation, or educational placement of the child or the provision of  FAPE to the child. 

For guidance Prior Written Notice, including the actions and refusals requiring or not requiring a PWN, click here. 

The determination of the significance of a change must be made on a case-by-case basis. Each IEP team must use professional judgment in this decision. In instances of uncertain significance, the best practice would be to document the action using a Prior Written Notice form.

Outside sources: 

A team may include information provided from outside sources in the PWN. Outside sources do not include school or AEA  personnel and AEA/LEA staff should clearly identify any outside sources of PWN information in response to relevant prompts and determine the best “fit” for the information. 

Documentation Refused Actions:

Parents may request an action that does not become the outcome of the IEP team discussion. For example, parents may request that a level of service be maintained when it is recommended that a lesser level of service is sufficient or parents may request an evaluation and the eventual decision is that existing information will support necessary actions and decision making.  Do not assume that consensus has been reached, that the parents are no longer requesting something and that a Prior Written Notice of refusal is not needed. Parents may acquiesce at the moment but remain unconvinced. Check to be sure that parents agree with and support actions that are different than what they have requested.  Communicate with parents in a forum where the parents are comfortable responding (e.g., ask privately, if the parents may be reluctant to express their opinion in the IEP team setting). If there is any doubt about the parents’ acceptance of an IEP team decision regarding a parent request, provide a Prior Written Notice of refusal.

PROMPT: A copy of this manual was provided on

DOCUMENT: Enter the most recent date the parents were provided a copy of the Procedural Safeguards  Manual for Parents. (This could be the date of the PWN, the date of the last meeting, or one of the other times parents are provided a copy of the manual).

PROMPT: The purpose of this notice is:  

  • An action is being proposed. 
  • An action is being refused.

DOCUMENT: Select one.

PROMPT: A description of the action proposed or refused

DOCUMENT: Describe the action proposed or refused by the agency (AEA, school district, or both).

Examples: 

  • Physical therapy (80 minutes per month) will be added to the services provided to Maria. 
  • John’s special education support in reading will be reduced from 60 minutes daily to 30 minutes daily. 
  • Pedro was identified as learning disabled in Montana. He will be identified as an eligible individual.

PROMPT: An explanation of why the school proposes or refuses to take the action

DOCUMENT: State why the agency proposes or refuses to take the action. 

Examples: 

  • During Maria’s recovery from surgery physical therapy is needed to allow her to participate as fully as possible in her educational program. 
  • John is able to apply phonics and word analysis skills in decoding words. Work on these skills is no longer needed but special education services in reading focused on comprehension skills will continue. 
  • Iowa prefers to identify students requiring special education without designating a disability category.

PROMPT: A description of any other options the school considered and the reasons why those options were rejected

DOCUMENT: If no other options were considered, state that.  

Examples: 

  • No other options were considered for Maria. 
  • Maintaining John’s past level of service was considered. Given John’s mastery of decoding skills and growth in comprehension skills, 60 minutes of support per day is not needed. 
  • Maintaining Pedro’s identification as learning disabled was considered. No advantage to doing so was identified through team discussion. 

PROMPT: A description of each evaluation procedure, test, record, or report the school used as a basis for the proposed or refused action

DOCUMENT: Describe the sources of information used. 

Examples: 

  • Information and recommendations from Maria’s family physician, surgeon, and hospital physical therapist were considered. 
  • Curriculum-based progress monitoring, teacher observations and recommendations, and Iowa Assessment results. 
  • School records from Pedro’s former school, including his last IEP and the evaluation report documenting his disability.

PROMPT: A description of any other factors that are relevant to the school’s proposal or refusal

DOCUMENT: Describe any factors that were not noted in the previous items. If no other factors were relevant to decision making, state that (e.g., not applicable, none, etc.). 

Examples: 

  • Not applicable.
  • Parent preferences for John’s program communicated to his special education teacher at school conferences.
  • No other factors were relevant to the proposal for Pedro.

PROMPT:  Is the proposed action change in the identification, evaluation, services, supports, or placement? YES/NO

DOCUMENT: Select YES or NO.

PROMPT:  If “yes,” when will this action be implemented?

DOCUMENT: State the date when this proposed change will become effective. Teams must provide a reasonable amount of time before a change. The “reasonableness” is determined by the IEP team. 

  • A date reflecting an immediate change may be reasonable if action is urgent and the team agrees.
  •  A date in three weeks may be reasonable if a parent requests the opportunity to discuss the proposed change with their spouse who is traveling and unavailable for several weeks. 
  • A date indicating the start of school in the fall may be reasonable when only a few days remain in the current school year. 
  • IEP teams will need to consider the particular circumstances when making this decision.

PROMPT: If you have questions, please contact the school principal or district/AEA designee. Provide information for a  contact person who can answer parent questions regarding this notice.

DOCUMENT: Enter a name, position, phone, and email for the person to contact.

Consents

Consent for Full and Individual Initial Evaluation (FIIE)

Overview

When a public agency (the AEA or the AEA in conjunction with the LEA) suspects that the child may have a disability and needs special education and related services, the AEA will seek consent to complete a full and individual initial evaluation.

PROMPT: Name & Other Demographic Information

DOCUMENT:  It is imperative that the demographic information is complete and accurate. This includes the individual’s name, date of birth, resident and attending district information, and parent information.

PROMPT: Teacher/Service Provider

DOCUMENT:

  • For PK- 12th grade students, identify the child’s general education teacher. 
  • For a preschool-age child who is not in any school, enter “Not applicable”. 
  • For a school-aged child receiving competent private instruction (homeschooling) enter the name of the parent(s) or an educator identified by the parents. 
  • For a child transitioning from Pact C (infant and toddler services), identify the Early ACCESS service coordinator who has primary responsibility for the Individualized Family Service Plan (IFSP).

PROMPT: Language spoken in the home/interpreter needs

DOCUMENT: Identify the language spoken in the home. Indicate interpreter needs (for the child/student for the evaluation and/or for the parent(s) at meetings).

PROMPT: Explanation of why the school or AEA proposes to initiate an evaluation

DOCUMENT: Provide the foundation in the Iowa Administrative Rules of Special Education for the evaluation and state that this evaluation will assist the team in understanding the child’s needs in the areas of instruction, curriculum, the learning environment, and other areas.

Examples:

  • General education interventions have not been effective in solving problems your child is experiencing and special education services may be needed.
  • General education interventions have been effective but require continued and substantial efforts that may include special education services.
  • Based on [your child’s school performance, screening results, etc.] we (school or AEA) believe there is reason to suspect that your child has a disability and special education services need to be considered.
  • Your child’s injury has created an immediate need for specialized services.
  • You have requested an evaluation and we (school or AEA) believe there is reason to suspect that your child has a disability and special education services need to be considered. This evaluation will assist us in understanding your child’s needs in the areas of instruction, curriculum, the learning environment, and other areas.

PROMPT: Description of other options the school or AEA considered and the reasons why those options were rejected

DOCUMENT: Indicate other options considered and the reasons they were rejected. 

Example: The continuation of general education interventions was rejected due to lack of success.

PROMPT: Domains

DOCUMENT: Indicate the domains that align with the areas to be evaluated. This should correspond to the areas of concern that were identified through the “disability suspected” process.

PROMPT:  Procedural Safeguards were reviewed by

DOCUMENT: Identify the individual who provided the parents with their procedural safeguards and the method used.

PROMPT: Signature

DOCUMENT: Both parents may sign, but only one parent signature is required for all initial evaluations. An electronic signature is available. However, if the electronic signature option is not utilized, upload a copy of the signed printed copy of the form to “Associated Files” of the IEP. When uploading the file to associate files, label the file “Consent for FIIE, (date signed)” For example: “Consent for FIIE, 11/30/20” For additional information who can fill the role of parent, click here

Consent to Receive Electronic Communication

 

Overview

Prior to sharing IDEA-related information electronically with parents, the AEA/LEA must obtain written informed parental consent.

PROMPT: Parent signature

DOCUMENT: At least one parent signature is required for “consent” or “do not consent.” 

An electronic signature is available. However, if the electronic signature option is not utilized, the following steps must be completed: 

  1. The signed printed copy of the form must be uploaded to “Associated Files” of the IEP. When uploading the file to associate files, label the file “Consent for Electronic Communication, (date signed)” For example: “Consent for E-Comm, 11/30/19” 
  2. On the Consent to Receive Electronic Communication form with the IowaIDEA Web IEP, staff must indicate if parents “consent” OR “did not consent” AND enter the date the consent was signed. 

PROMPT: Date

DOCUMENT: The date entered is the date the “consent” or “do not consent” was signed by the parent(s). Once the date is entered, it will auto-populate in the top right corner of the form. The consent status and date of the most recent consent will appear on Page A of the IEP.

Special Notes:
  • For all current IEPs: Effective July 2019, the Consent to Receive Electronic Communication form will be available under the “Additional Forms” tab. The form will also be available between IEP meetings via the ‘Forms for Active IEP’ and ‘New IEP Planning’ buttons on the IEP Overview screen of the IEP application.  
  • In order to ensure the Consent to Receive Electronic Communication form is completed for every active IEP, the form will be required for the first naturally occurring IEP (review, reevaluation, interim) after July 1, 2019. 
  • The Consent to Receive Electronic Communication form will need to be completed prior to choosing ‘ready to review’ for the IEP. 
  • The form will be available, but not required, for amendments, move-in IEPs, and attending-out-of-state IEPs. However, if the form already exists (created via “Forms for Active IEP”) the form will not be required on the first naturally occurring IEP after July 1, 2019. 
  • If the parent has previously “consent” and later chooses “do not consent” or vice versa, a new Consent to Receive Electronic Communication form will need to be created.  Follow the same process and document the required date, status, and signature to complete the new consent. 

Consent for Initial Special Education and/or Related Services

 

Overview

Prior to the initial provision of special education services, the AEA or LEA must obtain informed written consent from the parent(s)

The Consent for Initial Special Education and/or Related Services form must be used in conjunction with the Prior Written Notice form. The Prior Written Notice form should be completed and reviewed with the parents to ensure the parent understands the options considered and is in agreement with the recommendations. 

The Prior Written Notice form and a signed Consent for Initial Special Education and/or Related Services form documents that parents have been provided appropriate notice and have given written consent for these services, as documented in the IEP, to begin. The date consent for service was given is entered on Page A of the initial IEP in the “from” field of “Duration of this IEP”. Therefore, this date entered on an initial IEP specifies both the effective date of consent and the date this initial IEP is in effect.

PROMPT:  Meeting Date

DOCUMENT: The actual date the meeting is held to develop the initial IEP.

PROMPT: Name & Other Demographic Information

DOCUMENT: It is imperative that the demographic information is complete and accurate. This includes the individual’s name, date of birth, resident and attending district information, and parent information.

PROMPT: Signature of Parent or Guardian

DOCUMENT: Both parents may sign, but only one parent signature is required for all initial evaluations.  An electronic signature is available. However, if the electronic signature option is not utilized, upload a copy of the signed printed copy of the form to “Associated Files” of the IEP. When uploading the file to associate files, label the file “Consent for Initial Services, (date signed)” For example: “Consent for Initial Services, 11/30/20”  For additional information who can fill the role of parent, click here.

PROMPT:  Date

DOCUMENT: If the parent(s) consent to services, enter the date of signature in the Web IEP (Forms tab, Signatures subtab). The date consent for service was given is entered on Page A of the initial IEP in the “from” field of “Duration of this IEP”. Therefore, this date entered on an initial IEP specifies both the effective date of consent and the date this initial IEP is in effect.

Consent for/Notice of Reevaluation

Overview

Consent is required for reevaluations when assessments, in addition to the review of existing information, will be conducted. The following requirements apply. 

“Consent” is obtained when all of the following conditions are satisfied:

  1. The parent has been fully informed of all information relevant to the activity for which consent is sought, in his or her native language, or through another mode of communication; 
  2. The parent understands and agrees in writing to the carrying out of the activity for which parental consent is sought, and the consent describes that activity and lists the records (if any) that will be released and to whom; and
  3. The parent understands that the granting of consent is voluntary on the part of the parent and may be revoked at any time. [281—41.9] 

If the parent refuses to consent to a reevaluation, the public agency may, but is not required to, pursue the initial evaluation of the child by utilizing … procedural safeguards, including the mediation procedures or the due process procedures. An AEA does not violate its obligation to evaluate if it declines to pursue an evaluation or reevaluation. 

Exception. Informed parental consent for a reevaluation need not be obtained if the public agency can demonstrate that: (1) It made reasonable efforts to obtain such consent; and (2) The child’s parent has failed to respond

PROMPT: Teacher/Service Provider

DOCUMENT: Identify the special education service provider (teacher, AEA support staff) who has primary responsibility for the IEP.

PROMPT: Language spoken in the home/interpreter needs

DOCUMENT: Identify the language spoken in the home. Indicate interpreter needs (for the child/student for the evaluation and/or for the parent(s) at meetings).

PROMPT: Explanation of why the school or AEA proposes to initiate an evaluation

DOCUMENT: Provide the foundation in the Iowa Administrative Rules of Special Education for the evaluation and provide information on the child’s needs in the areas of instruction, curriculum, the learning environment, and other areas. 

Examples: 

  • It has been three years since your child’s last evaluation. 
  • You have moved to Iowa from another state and additional information is needed to determine your child’s eligibility for special education services in Iowa. Special education services will continue while this reevaluation is completed. 
  • Based on [your child’s school performance, screening results, etc.] we (school or AEA) believe there is reason to believe that your child has special education needs in additional areas and further evaluation information is needed. 
  • You have requested a reevaluation.

PROMPT: Description of other options the school or AEA considered and the reasons why those options were rejected

DOCUMENT: Indicate other options considered and the reasons they were rejected. 

Example: No other options were considered. (This is always the correct response for required reevaluations -i.e., three years, parent or teacher request, consideration of exit from all services, etc.)

PROMPT: Domains

DOCUMENT: If the team has determined that additional assessments must be conducted, indicate the domains that align with the areas to be evaluated.

PROMPT: Domains

DOCUMENT: Indicate the domains that align with the areas to be evaluated. This should correspond to the areas of concern that were identified through the “disability suspected” process.

PROMPT:  Procedural Safeguards were reviewed by

DOCUMENT: Identify the individual who provided the parents with their procedural safeguards and the method used.

PROMPT: Signature

DOCUMENT: Signed, parent consent is required for all evaluations. Both parents may sign, but only one parent’s signature is needed.  An electronic signature is available. However, if the electronic signature option is not utilized, upload a copy of the signed printed copy of the form to “Associated Files” of the IEP. When uploading the file to associate files, label the file “Consent for Reevaluation, (date signed)” For example: “Consent for Reeval, 11/30/20” For additional information who can fill the role of parent, click here

Reevaluation exception: The informed parental consent need not be obtained if the public agency can demonstrate that: (1) It made reasonable efforts to obtain such consent; and (2) The child’s parent has failed to respond. [41.300(3)b]

 

Parent/Guardian Authorization for Medicaid Reimbursement

 

Overview

IDEA requires that parent consent be obtained in order for public agencies (AEAs or LEAs) to access a child’s public insurance coverage (i.e., Medicaid). Because the claiming process requires the release of educational information to Iowa Medicaid, parent consent is also required for information release. 

2013 changes to IDEA regulations require one-time consent for sharing data and billing Medicaid. Each agency (AEA or school district) is required to have its own consent from the parents. 

For example: 

  • If the AEA provides physical therapy services and the school district provides a health service, both the school and the AEA require signed consent for information release and billing.
  • If a child moves to a new district, the new district would need to obtain consent before billing. If the new district is in a different AEA, the new AEA would need to obtain consent before billing

PROMPT:  Refusal of Consent or Withdrawal of Consent

DOCUMENT: Indicate, by checking, the parent’s decision to refuse consent or withdraw previously given consent.

PROMPT: Signature

DOCUMENT: A parent signature on this line indicates the parents’ decision regarding Medicaid claiming.

Home School Parent Notification and Acknowledgment

 

Overview

When a parent informs the district of their plan to enroll their eligible student in homeschooling, the AEA/district must explain the parent’s options for dual enrollment for special education services. Particularly important is explaining to parents that if they choose not to dual enroll their child for special education services, they have effectively revoked their consent for special education and that this decision has specific consequences. 

If the parents plan to dual enroll for special education services, 

The team must: 

  • Complete the Home Schooling for Students in Special Education: Parent Notification and Acknowledgment form, including seeking a parent signature. 
  • Develop an IEP

Parents must: 

  • Submit Form A, and 
  • Seek Director (or Director designee) approval for dual enrollment. 
If the parents do not plan to dual enroll for special education,

The team must: 

  • Inform parents that their decision effectively revokes their consent for their child’s special education services 
  • Complete the Home Schooling for Students in Special Education: Parent Notification and Acknowledgment form, including obtaining parent signature, 
  • Complete a Prior Written Notice. 
  • Provide parents a copy of the form and Prior Written Notice and offer a copy of the Procedural Safeguards Manual for Parents, 
  • Exit the student. 

If the student re-enrolls in school in the future, eligibility will need to be redetermined through the initial evaluation process regardless of the length of time. Consideration of all relevant, existing information may be used in determining eligibility. 

If the parents do not plan to dual enroll for special education, but the parents will not meet to discuss homeschool options and participate in the completion of the Home Schooling form or the parents will not sign the Home Schooling form,

The team must: 

  • Complete the form, without parent signature, indicating who reviewed information regarding special education and homeschooling, when the information was reviewed, and how the parents were informed, 
  • Complete the Prior Written Notice, 
  • Provide parents a copy of the form and Prior Written Notice and offer a copy of the Procedural Safeguards Manual for Parents, 
  • Exit the student. 

If the student re-enrolls in school in the future, eligibility will need to be redetermined through the initial evaluation process regardless of the length of time. Consideration of all relevant, existing information may be used in determining eligibility.

PROMPT: Name & Date of Birth

The student’s name and date of birth are pre-populated on the form.

PROMPT: Acknowledgment of Information I acknowledge that information about homeschooling for students in special education has been reviewed with me and I understand the potential implications for my child. Please check the appropriate box below and sign. 

  • I wish to dual enroll my student to receive special education services.
  • I request that my student’s special education services be discontinued as I will be homeschooling and do not wish to dual enroll for special education services.

DOCUMENT: Indicate the parent’s decision by selecting the corresponding box.

PROMPT:  Signature of Parent or Guardian

DOCUMENT: Both parents may sign, but only one parent’s signature is required.  An electronic signature is available. However, if the electronic signature option is not utilized, upload a copy of the signed printed copy of the form to “Associated Files” of the IEP. When uploading the file to associate files, label the file “Homeschool Form, (date signed)” For example: “Homeschool form, 11/30/20”  For additional information who can fill the role of parent, click here.

PROMPT: Date

DOCUMENT: Indicate the date the parent(s) signed.

PROMPT: Information Reviewed By

DOCUMENT: Indicated the name of the district or AEA staff member who informed the parent(s).

PROMPT: In-Person OR Via Phone

DOCUMENT: Select which method was used to inform the parents.

PROMPT: Date

DOCUMENT: Indicate the date the information was shared with the parents. 

Authorization for Exchange of Information

Overview

In general, written consent must be given by the parent, legal guardian or eligible students to release student records or disclose the personally identifiable information contained in those records to other persons or agencies. 

Written consent must state which records are released, to whom they are released, and the reason for the release. For exceptions to the general rule regarding consent for disclosure, see Student Records & Disclosure of Information Without Parent Consent.

It is advisable to check with the medical professional or institution in advance regarding acceptable disclosure consent documentation.

For most students, the parents will have the authority to give consent for the exchange of information. Some students will have a guardian or extended educational decision-maker who will be able to give consent. A student who has reached the age of majority and does not have an appointed guardian or extended educational decision-maker must be the one to grant consent to exchange information.

PROMPT: Name & Other Demographic Information

DOCUMENT: It is imperative that the demographic information is complete and accurate. This includes the individual’s name, date of birth, resident and attending district information, and parent information.

PROMPT: The purpose for the exchange of information

DOCUMENT: State why information is needed.

Examples: 

  • AEA and school information is needed to assist the clinic to complete an independent educational evaluation. 
  • Medical information is needed to develop Jennifer’s individual health plan.

PROMPT: Your signature will give your permission for the following specific information to be exchanged.  Medical Status, Current Medications/treatments, Recommendations for School, Other: (text field)

DOCUMENT: Identify the information that will be shared if permission is given.

PROMPT: Information in the following areas may not be exchanged without your special permission. Information related to mental health, substance abuse/chemical dependence, sexually transmitted disease, or HIV/AIDS is protected from disclosure and requires special permission.

DOCUMENT: If permission is being sought to exchange information in any of these areas, select each area to be included.

PROMPT:  Your signature will give your permission for the exchange of information by the methods indicated: 

Yes/No The exchange of written records containing the information described in this release by the agencies or individuals specified 

Yes /No The verbal exchange of the information described in this release by the agencies or individuals specified

DOCUMENT: Select Yes or No for the method(s) that will be used to exchange information. Note: Permission to exchange records does not confer permission to exchange information in other ways. 

PROMPT: This authorization is good until the following date [date]

DOCUMENT: Indicate the period of time for which this permission to exchange information will be in force. Do not exceed one year.

PROMPT: Contact

DOCUMENT:  Identify a contact person, including agency/district, address, email, and phone number.

PROMPT: Signature

DOCUMENT: An individual over 18 who is his or her own guardian or must sign, not a parent. For individuals under 18, a parent signature is required. Both parents may sign, but only one parent’s signature is needed.  An electronic signature is available. However, if the electronic signature option is not utilized, upload a copy of the signed printed copy of the form to “Associated Files” of the IEP. When uploading the file to associate files, label the file “Exchange of Info, (date signed)” For example: “Exchange of Info, 11/30/20” For additional information who can fill the role of parent, click here.

PROMPT:  If “yes,” when will this action be implemented?

DOCUMENT: Identify the individuals and agencies involved in the exchange of information. 

If medical service providers (physicians, clinics, etc.) are included, please note that the confidentiality of medical information is protected by the Health Insurance Portability and Accountability Act (HIPAA). Medical professionals and institutions operate in the manner in which they have been advised to be HIPAA compliant. To avoid unnecessary delays, it is advisable to check with medical professionals or institutions in advance regarding acceptable information disclosure consent documentation.

PROMPT: Name

DOCUMENT: Individual to whom records are to be delivered and/or has permission to discuss the specified information.

PROMPT: Agency/Relationship

DOCUMENT: Indicated the name of the agency and the relationship. For example, Foothills Health Clinic (agency); Psychiatrist (relationship).

PROMPT: Address/Phone/Fax

DOCUMENT: Complete accurately and completely the information needed for the information exchange.

Authorization for Release of Health and/or Educational Information

Overview

The Authorization for the Release of Health and/or Educational Information was designed by medical and health providers. However, agencies and individuals providing medical services are covered under the rules of the Health Insurance Portability and Accountability Act (HIPAA). In order to comply with HIPAA regulations, those agencies and individuals may require that their own release forms be used. It is advisable to check with the medical professional or institution in advance regarding acceptable disclosure consent documentation. 

Note: To obtain records from the University of Iowa Hospitals and Clinics, including Child Health Specialty Clinics, follow this link to assure you that you are using their current release: University of Iowa Consent to Release Information

PROMPT: Name & Other Demographic Information

DOCUMENT: It is imperative that the demographic information is complete and accurate. This includes the individual’s name, date of birth, resident and attending district information, and parent information.

PROMPT: On behalf of the above named student, I authorize (Name of health care provider, agency, or medical institution) to release evaluation records to and (Area Education Agency) (School or School District)

DOCUMENT:  Indicate the name of the health care provider, agency or medical institution, the AEA and the school district..

PROMPT: AEA and LEA Contact and Address

DOCUMENT: Indicate the name of the AEA/LEA Contact and their address. 

PROMPT: Timeframe

DOCUMENT: Indicate the period of time from which records are sought- start and end dates. The source may have years and years of records. Make sure you are getting the records you want without overburdening the source or filling the individual’s educational file with out-of-date and potentially irrelevant information.

PROMPT: Information to be shared: Current Medical Status, Current Medications/treatments, Recommendations for School, Other (text field)

DOCUMENT: Select the areas of information that will be shared if permission is given.

PROMPT: I hereby give special permission… Information related to mental health, substance abuse/chemical dependence, sexually transmitted disease, or HIV/AIDS is protected from disclosure and requires special permission

DOCUMENT: Select the areas of information that will be shared if permission is given.

PROMPT: If permission is being sought to exchange information in any of these areas, each area must be specifically identified. This authorization is valid until ….

DOCUMENT: Indicate the period of time for which this permission to exchange information will be in force. Do not exceed one year.

PROMPT: Signature, Relationship to student, Date and Printed Name

DOCUMENT: An individual over 18 who is his or her own guardian or must sign, not a parent. For individuals under 18, a parent signature is required. Both parents may sign, but only one parent’s signature is needed.  An electronic signature is available. However, if the electronic signature option is not utilized, upload a copy of the signed printed copy of the form to “Associated Files” of the IEP. When uploading the file to associate files, label the file “Release of Health Info, (date signed)” For example: “ Release of Health Info, 11/30/20” For additional information who can fill the role of parent, click here.