Santa Barbara County
Special Education Local Plan Area _____________________A Joint Powers Agency
_________________________________
DISTRICT
DATE________________
NOTIFICATION OF MEETING AND INTENT TO PARTICIPATE
STUDENT_________________________________PARENT/GUARDIAN ____________________________
PRIVATE SCHOOL STUDENT
SERVICES PLAN MEETING
DATE:________________ TIME:___________ PLACE: __________________________________________
THE PURPOSE(S) OF THE MEETING WILL BE TO DEVELOP, REVIEW, AND/OR REVISE, AS
APPROPRIATE, A SERVICES PLAN FOR THE CHILD WHOSE NAME APPEARS ABOVE.
THE FOLLOWING PERSONS HAVE BEEN INVITED TO ATTEND:
___ Administrator
___ Program Specialist
___ Nurse
___ Special Class Teacher
___ Speech/Language Specialist
___ Student
___ Resource Specialist
___ Regular Class Teacher
___ Psychologist
___ Private School Representative
___Others: __________________________________________________________________________
____________________________________________________________________________________
PLEASE CHECK ONE OF THE FOLLOWING:
___
___
___
___
I will attend the meeting.
I will attend the meeting and bring the following person to speak for me: __________________________
I cannot attend the meeting at the scheduled time. Please schedule a new time for the meeting.
I do not wish to attend the meeting or to appoint someone to speak for me. I understand that a school
representative will contact me to explain the recommendations included in the Service Plan. I will
receive a copy of the Service Plan.
________________________
_________
Signature of Parent/Guardian/Adult Student
Date
PARENTS: PLEASE KEEP YELLOW COPY AND RETURN WHITE COPY OF FORM TO:
_______________________________________________
_______________________________________________
By:____________________________________________
Date
(A COPY OF THE SELPA PARENTAL AND ADULT STUDENTS’ RIGHTS
IS ENCLOSED WITH THIS MEETING NOTIFICATION)
SELPA 27 (E) (1/09/01)