SACRAMENTO COUNTY - SPECIAL EDUCATION LOCAL PLAN AREA
SURROGATE PARENT AGREEMENT
This Surrogate Parent Agreement (“Agreement”) is made and entered into effective <date here>, between the Sacramento County SELPA and <name of surrogate parent here> with respect to the following recitals: A. District desires to fulfill its obligation to appoint a surrogate parent to represent a special education student to ensure that the student obtains a free and appropriate education under the Individuals with Disabilities Education Act (“IDEA”) and state law.
B. Surrogate Parent has expressed a desire and willingness to act as the Student’ s Surrogate Parent for educational purposes.
NOW, THEREFORE, THE PARTIES AGREE AS FOLLOWS:
1. Appointment: SELPA hereby appoints Surrogate Parent to act as the surrogate parent for <student name here>, D.O.B. <student’s date of birth here>.Surrogate Parent ag rees to act as the “Parent” and educational representative for Student in accordance with 34 Code of Federal Regulations Section 300.519,Education Code 56050, Government Code 7579.5, and other applicable provisions of state and federal law. 2. Representations: Surrogate Parent represents that he or she has no interest that conflicts with the interest of the Student and that Surrogate Parent is not an employee of any agency involved in the care, custody or education of Student. Surrogate Parent further agrees to act on behalf of Student and to advocate for the education of Student in all ways necessary to ensure that Student receives a free and appropriate public education. Surrogate Parent agrees to meet with Student, as appropriate, and others and to review St udent’s educational records to develop knowledge and understanding of Student’s disability and Student’s individual needs for special education and related services. If at any time during the term of this Agreement, Surrogate Parent develops an interest which may conflict with the interests of Student or becomes an employee of an agency involved in the care, custody or education of Student, Surrogate Parent agrees to immediately notify the SELPA. Upon verification, the SELPA shall terminate this Agreement. 3. Training: Surrogate Parent acknowledges that the SELPA has provided training regarding Student’s disability, the laws applicable to Surrogate Parent responsibilities, and the continuum of program placements and opportunities available in the Sacramento County SELPA.
4. Term: SELPA hereby appoints Surrogate Parent for a term of two (2) years.
5. Termination: Either party may terminate this Agreement for any reason upon thirty (30) days written notice to the other party.
Chapter 4 – Procedural Safeguards, Charter SELPA
Page 99
As of 11/18/2016
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