Note: Two step Referral PET
WRITTEN NOTICE
MSER Appendix 1, 34 CFR 300.503
(State of Maine Required Form)
Date: June 15, 2007
Date sent to parents: June 17, 2007
Attending School Unit: Tim Horton Elementary School Region 2
Prior Written Notice must be given in accordance with MSER Appendix 1, 34 CFR 300.503 for:
Initial Referral MSER Section IV.2.D
Consent for Initial Placement MSER Section V.1.A(4)(a)(ii)
Evaluation/reevaluation MSER Sections V.1.A(4)(a)(i) & V.3.D
Annual Review and other IEP Program /Placement/Changes including Graduation
MSER Sections XV 34 CFR 300.503
Amendments after the Annual IEP Meeting MSER Section IX.3.C(4)
Dear Parents/Guardian: Mr. & Mrs. Hance
Child’s Name: George Hance
At least 7 days prior to the date upon which the school unit proposes or refuses to initiate
or change the identification, evaluation, educational program, placement or the
provision of early intervention services for your child age birth to 2 years, or a free
appropriate public education (FAPE) to your child age 3 through 20 years you must be
provided the following notice. (MSER Appendix 1, 34 CFR 300.503)
1. Describe the action(s) regarding the referral, evaluation, identification,
programming or placement proposed or refused by the SAU.
George’s referral to Special Education was accepted due to the concern for his
difficulties in Math.
IEP Team agreed for the following evaluations: intelligence, general academic,
classroom observation, specific Math evaluation
2. Explain why the SAU is proposing or refusing to take the above action(s).
George has made very little progress in Math year (3 months gain only)
Mrs. Clock (teacher) has worked through the SAT for 5 months following their
recommendations to no avail.
Parents have hired a tutor to work with George at home though still minimal
progress. Parents agree with the referral.
Evaluation being proposed to determine if George is eligible for Special
Education.
3. Describe each evaluation procedure, assessment, record, or report the SAU used
as a basis for the proposed or refused action. (s).
District assessment; Informal assessment by the classroom teacher and Chapter
I program; Documentation of progress through the SAT
Note: Two step Referral PET
4. Describe any other options that the IEP team, which includes the parent,
considered and the reasons why those options were rejected.
Considered continuing with Chapter I assistance however the SAT Team believes
with the tutoring at home and the attempts the school has made, the lack of
progress warrants a referral to Special Education to determine if George has a
Learning Disability in other area of Math.
5. Describe any other factors that are relevant to the SAU’s proposed or refused
action(s) described above.
George is on grade level in all other academic areas.
Parents agreed with proposed evaluations and signed evaluation consent form.
6. Description of the points made by the parent including description of their child’s
progress.
Parents have met several times informally with Mrs. Clock (classroom teacher),
Mr. Coulombe (principal) and Mr. Serious Data (Chapter One teacher) to discuss
progress and possible attempts to assist Mrs. Clock. They are pleased with the actions
of the staff however concerned that George still has made minimal progress.
As parents of a child with a disability or (suspected disability) you have protections
under the procedural safeguards of the Maine Special Education Regulations. For initial
referrals, a copy of those safeguards is enclosed. For reasons other than initial referrals
34 CFR 300.504 describes circumstances when you are required to be given a copy.
Sources for parents to contact to obtain assistance in understanding the provisions
described in the procedural safeguards or how to obtain a description of the procedural
safeguards are by contacting Kristin Cyr at 989-5206, the Due Process Office of the
Maine Department of Education (207-624-6650),
http://www.state.me.us/education/speced/specserv.htm, Maine Parent Federation (1-800870-7746), the Disability Rights Center (1-800-452-1948) and Southern Maine Parent
Awareness (1-800-564-9646) or KIDSLEGAL at 866-624-7787.
Parental signature for consent for initial provision of special education and when
appropriate, related services as stated above. (This signature is needed for initial
provision of services only.)
Parental Signature and Date
Signature: ___________________________________
Date: __________________
IEP Members attending IEP meeting or participating in Amended IEP process as defined
in 34 CFR 300.324(a)(4) & MSER IX.3.C(4) &(6)
Name:
Mr. & Mrs. Samuel Hance
Mrs. Jayne Clock
Mr. Thomas Norton
Mr. Mark Coulombe
Position:
Parents
Classroom Teacher
Special Education Teacher
Principal
Note: Two step Referral PET