127 Hartford Avenue

Wethersfield, CT 06109

REVOCATION OF CONSENT FOR SPECIAL EDUCATION SERVICES

I, ______, state that I have authority to make educational decisions for ______and, in that capacity, I hereby revoke my consent for the continuation of special education and related services for ______, effective immediately. By revoking my consent for such services, I understand that the Wethersfield Public School District:

1.  Will have no continuing obligation to provide, under the Individuals with Disabilities Education Act (“IDEA”) or any other state or federal law, including Section 504 of the Rehabilitation Act of 1973, my child a free appropriate public education (“FAPE”), hold Planning and Placement Team (“PPT”) meetings, develop an Individualized Education Plan (“IEP”), or provide special education or related services;

2.  Had previously identified my child as eligible for special education and related services, had provided special education and related services to my child, and is now terminating my child’s special education and related services based solely on my revocation of consent for such services;

3.  Is required to issue a notification that such services will be terminated before the services end, and this will result in a temporary continuation of services;

4.  Will treat my child as a regular education student for all purposes, including, but not limited to, placement, curriculum, and discipline;

5.  Shall consider my revocation of consent a waiver of any right to claim that the above named student is exempt from discipline because of a disability;

6.  Will continue to include my child in the “child find” process (through which students are identified as potentially eligible to receive special education services) and may refer my child for an initial evaluation. I also understand that I may refer my child for evaluation at any time;

7.  Will not resume providing special education and related services, unless my child undergoes an initial evaluation, is determined to be eligible for special education and related services, and I consent to the initiation of services.

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Signature Date

Revised 9/5/15 (rz)