CONFIDENTIAL

Special EducationDepartment

407 Central Ave

Grambling, LA71245

Phone: (318) 274-6153

FAX: (318)274-3215

Waiver for TriennialRe-EvaluationDATAREVIEW:

Student:

School: Date ofBirth:

State ID#:

Grade:

Parent(s): Address:

TelephoneNumber: ______

Exceptionality: ExceptionalityDetail: RelatedServices:

Review of Current Performance: (The following checked items werereviewed)

Report cardgradesHearing/Vision

Progress monitoringdataAssistiveTechnology

Standardized testscoresProgressreports

Progress toward meeting annual IEPgoalsInformationprovidedbyteachers

Transitional/VocationalinformationInformationprovidedbyrelatedserviceproviders

MedicalInformationInformationprovidedbyparent(s)

Discipline/FBA/BIPOther

Review of Current PerformanceIndicates:

Adequate progress is beingmade.

Progress has been minimal; however, documented interventions have been implemented toincreaseprogress. Adequate data exists to determine whether any additions or modifications to thespecial education and related services are needed to enable the student to meet the measurable annual goalsinthe IEP and to participate as appropriate in the general educationcurriculum.

Lack of progress indicates that a re-evaluation for further assessment isneeded.

Comments:

CO=Original; Copies To: Parent; School Confidential Folder; SpEd Teacher; Related Serv Providers

Page2:Waiver for TriennialRe-EvaluationDATAREVIEW:

Student: School: Date ofBirth:

State ID#:

Grade:

TheRegulationsforImplementationoftheChildrenwithExceptionalitiesAct,SubpartsAandB,Bulletin1706,requirethatare-evaluationbeconductedeverythreeyearsunlesstheparentsandthepublic agency agree otherwise. The triennial anniversary of the evaluation for the student listed aboveisapproaching.Baseduponareviewofyourchild’sprogressinhis/herclassroomandinputfromyourchild’s teacher(s), it has been determined that no additional data are needed to determine that yourchildcontinues to have an exceptionality and continues to need special education and relatedservices.

Furthermore, data shows that your child is making progress in meeting the measureable annual goalssetout in his/her IEP and is participating, as appropriate in the general education curriculum. Based onthisinformation,Lincoln Preparatory Schoolisrequestingyourpermissiontowaivethistriennialre- evaluation. The next triennial re-evaluation will be dueon (3year re-evaluationdate).

Are-evaluationmayberequestedatanytimebytheparentand/orteacherwhenitisdeterminedare- evaluation is necessary to provide additional data regarding new concerns or lack ofprogress.

Signature ofParent(s)/Guardian(s)Date

Signature of DistrictRepresentativeDate

If you need further information about this triennial re-evaluation waiver, you maycontact:Name:

Title:

Telephone: (318) 274-6153 or (318)274-3215

CO=Original; Copies To: Parent; School Confidential Folder; SpEd Teacher; Related ServProviders