Appendix B: Sample PWN 8
Parent Revocation of Consent to Special Education and Related Services
Date
Parent/Guardian Address Line 1 Address Line 2
Subject: Parent Revocation of Consent to Special Education and Related Services – Johnny Doe (DOB 01/11/00)
Dear Parent/Guardian,
This letter is in response to your letter dated 10/01/2014, in which you revoked consent for your child, Johnny Doe, to receive special education and related services from the Name of School District . Please consider this the District’s response to your request under 34 Code of Federal Regulations (C.F.R.) Sections 300.300 and 300.503. Based on the receipt of your revocation of consent, the District will discontinue all special education and related services for Johnny on Service End Date . After that date, Johnny will no longer receive the educational supports contained in his Date of Last IEP Individualized Education Program, which include, but are not limited to: List placement, services, accommodations, modifications, and supports, including behavioral supports child will no longer receive . Beginning on Date Student Will Start in General Education , Johnny will be placed in description of General Education placement . At that time, Johnny Smith will have access to list any supports, accommodations and/or opportunities made available outside of special education . Please be advised that after Date Prior to Start Date for Student in General Education , Johnny will be served entirely through a general education setting and will no longer be entitled to the special education and related services and protections provided under the Individuals with Disabilities Education Act (IDEA) and related provisions in the California Education Code. Johnny will be treated as a student in general education in all respects, including discipline (testing, and graduation, if appropriate). As a result, Johnny’s disability will not be taken into consideration when determining appropriate disciplinary action and he will not be entitled to the IDEA’s discipline protections. Therefore, we encourage you to consider the possible consequences of removing your child from special education and related services. Your revocation of consent for special education and related services releases the District from liability for providing your child with a free appropriate public education. If, in the future, you would like your child to receive special education and related services from the District, please contact us. The District will treat such a request as a request for an initial evaluation.
BP 1001 – Procedural Safeguards
Page 42
Desert Mountain Special Education Local Plan Area (DMSELPA) (rev. 03/13)
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