MARIN
Refusal to Assess SELPA
7/07
Prior Written Notice
Date
Student School
To
From
At an Assessment Planning Team (APT) meeting held on , the APT reviewed the request to assess your
son/daughter, , for an initial referral for special education a parent request for additional assessment
.
The APT reviewed the following and determined that an assessment is not indicated:
Attendance records Developmental history Cumulative records
Informal student interview/contact Results of the Student Study Team Observation of the student
Previous testing Special education file Input from classroom teacher
Information from parents regarding Input from administrative/ancillary Medical/Health records
concerns and current skills staff
Student work samples
Explanation of why the school district refuses to assess your child:
Description of any options the school district considered:
Description of any other factors that are relevant to the school district’s refusal:
PROCEDURAL SAFEGUARDS TO PROTECT PARENT’S RIGHTS
Procedural safeguards is enclosed was sent to parent/guardian by .
A copy of procedural safeguards must be provided to each parent of a student with a disability once per year unless the
student is initially referred, the parent requests an additional copy, or the parent initiates a due process complaint.
Please contact the Special Education Administrator at the phone number listed below for your school district if you:
Would like an additional copy of the Notice of Procedural Safeguards
Need assistance in understanding the provisions of your rights and safeguards
Require a translation, orally or by other means, in a different language or other mode of communication.
Contact Person Address Phone
If you need additional assistance, you may contact the Marin Special Education Local Plan Area (SELPA) at 499-5850.