Appendix A: SELPA Form DM 77
Notice of Procedural Safeguards (Parents’ Rights)
must be completed, and an IEP developed within 60 days of your consent. In the case of reevaluations, the LEA must document reasonable attempts to obtain parental consent. If the parents do not respond to these attempts, the LEA may proceed with the reevaluation without consent (34 CFR 300.300; EC 56506(e) and (d), and 56346). If you do not provide consent for an initial assessment or fail to respond to a request to provide consent, the LEA may pursue the initial assessment by utilizing due process procedures. If you refuse to consent to the initiation of services, the LEA will not provide special education and related services and will not seek to provide services through due process. If you consent in writing to the special education and related services for your child but do not consent to all of the components of the IEP, those components of the program to which you have consented must be implemented without delay. If the LEA determines that the proposed special education program component to which you do not consent is necessary to provide a free appropriate public education to your child, a due process hearing must be initiated. If a due process hearing is held, the hearing decision shall be final and binding. Consent to Bill California Medi-Cal: Release/Exchange Information for Health-Related Special Education and Related Services . LEAs may submit claims to California Medi-Cal for covered services provided to Medi-Cal eligible children enrolled in special education programs. The Medi-Cal program is a way for LEAs and/or County Offices of Education (COEs) to receive Federal funds to help pay for health-related special education and related services. Your consent is voluntary and can be revoked at any time. If you do revoke consent, the revocation is not retroactive. Consent will not result in denial or limitation of community- based services provided outside the school. If you refuse to consent for the LEA and/or COE to access California Medi-Cal to pay for health-related special education and/or related services, the LEA and/or COE is still responsible to ensure that all required special education and related services are provided at no cost to you. As a parent, you need to know that:
You may refuse to sign consent.
•
• Information about your family and child is strictly confidential.
• Your rights are protected under Title 34 of the Code of Federal Regulations 300.154 ; Family Education Rights Privacy Act of 1974 (FERPA); Title 20 of the United States Code Section 1232(g) ; and Title 34 of the Code of Federal Regulations Section 99 . • Your consent is good for one year unless you withdraw your consent before that time. Your consent can be renewed annually at the IEP team meeting.
BP 1001 – Procedural Safeguards
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Desert Mountain Special Education Local Plan Area (DMSELPA) (rev. 03/13)
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