Parent/Guardian/Surrogate

SUFFOLK PUBLIC SCHOOLS

WRITTEN NOTICE OF PROPOSED/REFUSED ACTION

Parent/Guardian/Surrogate: Student:

School: -Booker T. WashingtonCreeksideDriverElephant's ForkFlorence BowserHillpointKilby ShoresMack Benn, Jr.Mount ZionNansemond ParkwayNothern ShoresOaklandRobertsonSouthwesternForest GlenJohn F. KennedyJohn YeatesKing's Fork MiddleKing's Fork HighLakelandNansemond River DOB:

The Individuals with Disabilities Education Improvement Act (IDEA 2004) requires that a school division provide written notice to parents when the school division proposes or refuses to initiate or change the identification, evaluation, or educational placement of a child or the provision of a free appropriate public education (FAPE) to a child.

Suffolk Public Schools (SPS) has considered the following information:

1.  Description of the action proposed or refused by SPS:

Summarize everything that the team is proposing/ refusing.

2.  Explanation of why the action was proposed or refused by SPS:

Explain why the above actions were being recommended or rejected.

3.  Description of options (if any) considered by SPS and why those options were rejected (Attach an IEP Team Meeting minutes form if additional space is needed):

Please note everything that is discussed and considered during the meeting. Describe the decision and why the team came to that decision. If the team convened with a clear and agreed upon action, without additionl discussion please indicate that "No other action was considered at this time." You still must explain why nothing else was considered. This should not say "N/A."

4.  Description of each evaluation procedure, test, record, or report used by SPS as a basis for the proposed/refused action:

List all documents, data, and input that was reviewed during this meeting that helped the team to reach their decision.

5.  Description of any other factors (if any) relevant to the proposed or refused action:

Note any additional discussions during the meeting.

6.  Actions taken: Parent in attendance Yes No

Summarize the actions that the team decided to take.

To obtain assistance in understanding the provisions of this notice or another copy or the “Procedural Safeguards”, contact the administrator listed below, the Office of Special Education at 925-6764, or Parent-Teacher Resource Center at 925-5785.

This notice was provided to the parent/guardian/surrogate on by

Principal/Designee ______Telephone ______

Original – School Copy – School Admin. Office Copy - Parent