REVOCATION OF CONSENT
Date:
Student:
School:
District: ______________________________
The purpose of this letter is to revoke consent for my child to receive all special education services.
I understand and agree to the following:
I have received a copy of my rights. I know that if I disagree with the services being offered on
my child’s IEP, I have options to resolve the disagreement with the school district which include
the following:
Follow the correct chain of command at the school, school district, and state
levels;
Request a state IEP Facilitator to attend an IEP meeting;
Request a mediation meeting;
File an administrative complaint;
Request a due process hearing; or
Write a complaint to the Office of Civil Rights, US Department of Education.
I understand that, even though I disagree with the school district’s services that are being
provided, I am not required to take away my consent for my child to receive special education
and related services. I understand that for more information, I may contact the school district’s
special education director/supervisor, the Louisiana Department of Education, the Louisiana
Parent Training and Information Center at 1-800-776-7736, or the Families Helping Families
Resource Center in my area.
My child will not receive special education and/or related services.
My child will receive the same educational services and interventions available to any student
in the general education program and will be treated as a general education student, including
any disciplinary proceedings.
My child will no longer be provided additional disciplinary protection should he/she behave in a
manner that violates school policy or does not follow school rules, instead, he/she will be
disciplined in the same manner as any regular education student.
The school district will not hold any further IEP meetings for my child.
The school district is not required to remove references to special education and/or related
services from my child’s records.
Once my revocation is effective, my child will not be a child with a disability for educational
purposes. This means that my child will not be entitled to receive a free appropriate public
education (FAPE) as defined under IDEA, or receive protections he/she received when identified
as a child with a disability and an IEP.
If I should change my mind, the school district must conduct an initial special education
assessment to determine eligibility under IDEA and, if necessary, hold an IEP meeting to decide
if my child needs special education and/or related services.
Services to my child will be discontinued on: .
(date)
Signature of Parent(s)/Guardian(s) Date
Signature of District Representative Date