Stafford County Public Schools - Office of Special Education

Stafford County Public Schools - Department of Student Services

31 Stafford Avenue, Stafford, Virginia22554

(540) 658-6500 FAX (540) 658-6042

Initial

Triennial

Reevaluation

Other

PERMISSION FOR EVALUATION

STUDENT :
LAST / FIRST / MIDDLE / DATE: 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 200920102011201220132014201520162017201820192020
Student Number: / D.O.B. 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011
SCHOOL: ABESBESCESFALFFGESGVHOHWMBESMONPRRHRRSESWWWCHDSTEDSDSMSDMSGMSHHPSMSRTMSAGWSHMBPHSCFHSMVHSNSHSSHS / GRADE: Pre-KK123456789101112

The IEP team proposes that the following assessment components are necessary to determine if your son/daughter qualifies (or continues to qualify) for special education services.

Along with a review of your child’s current records,and the teachereducational report, the assessment includes the following:

PsychologicalVision ScreeningSocial History

EducationalBehavioral ScaleMedical

DevelopmentalAudiologicalSCPS will do Medical

Speech & LanguageAutism Rating ScaleParent will do Medical

Adaptive SkillsObservationOther:

Hearing ScreeningExplain:

The IEP team determined that no additional data are needed other than a review of your child’s current records, teacher(s) educational report(s) and observation. These will be used to determine if your child continues to qualify for special education services. (Triennial and reevaluations only.)

Please review this proposal and notify me if you desire a meeting to discuss the proposed evaluations. If acceptable, please sign and return to the school within five days of the date of this form. If this is an initial evaluation, a copy of your procedural safeguards is enclosed. A description of the assessment components is provided.

Sincerely,

Prior Written Notice

The IEP team proposes to conduct an evaluation to determine if your child requires or continues to require special education and/or related services. Options considered are noted above. A description of the nature, purpose and use of any of the evaluation procedures, tests, records or reports used are included. If any options relevant to this proposal were considered and rejected, the reason for their rejection may be included in a separate Prior Written Notice Document. You have protection under the procedural safeguards of the IDEA. If you need a copy of the procedural safeguards or need assistance in understanding the provisions of this notice, contact the designee at the school, the ParentResourceCenter at (540) 658-6710, or the Department of Special Education at (540) 658-6500.

Please check one box below, sign and return to your child’s school.

I/We agree to the assessment components and give permission to proceed with the evaluation.

I/We do not give permission to proceed with the evaluation.

Parent/Guardian Signature:Date:

Student Name: