Prior Written Notice – Disciplinary Change in Placement – DEC 5(a)
PRIOR WRITEN NOTICE
Decisions of the Local Education Agency (LEA)
Student: _______________________
DOB: ____________________
School: _______________________
Grade: _________
Dear Parent/Guardian:
State and federal laws regarding students with disabilities require that the Local Education
Agency (LEA) notify and inform you if certain changes are being made to your child’s educational
program. You must be informed when the school district:

Proposes to change the educational placement of your child.
This notice is to inform you that today your child violated the student code of conduct and
as a result he/she is subject to a disciplinary removal that will constitute more than 10
days of removal during this school year (including this action) and has been determined
by the school to be a change of placement.
A meeting to determine if the violation of student code of conduct is a manifestation of
your child’s disability will be held within 10 school days.
Also enclosed is a copy of the Handbook on Parents’ Rights. Please contact the school or the
Director of Exceptional Programs if you have questions about your rights, or you may call the
Exceptional Children’s Assistance Center, 1-900-962-6817.
Please respond to the enclosed Invitation to Conference and save this notice for your records.
If you have any questions, please call: ____________________________, ____________.
Name
phone
Sincerely,
Principal/Assistant Principal
Administrators: Send this notice to parents/eligible student with these required components on
the same day as the disciplinary removal.
□ Handbook of Parents’ Rights
□ Notification of disciplinary action including reasons and length of removal
□ An Invitation to the Manifestation Determination (IEP) meeting (Invitation/Prior Notice)
Prior Notice (this form) was given/sent to the parent by ____________________ on ___/___/___.
Method of delivery: ______________________________
Copy: EC file
4/08