Meeting Date: 04/02/2002 Name: Sample AA
Initiation Date: 05/02/2002 ID: 123456789
Date of Notice: 05/02/2002 School: Special Education Department
Time Meeting Started: 12:00 PM DOB: 01/12/1995
Time Meeting Ended: 12:00 PM Grade: 01
| Purpose of Notice |
| To determine need for assessment and sign consent to evaluate. |
| Actions Proposed, with Explanations of Why proposed |
| The school district proposes to initaite evaluation.
EXPLANATION Student is exhibiting academic difficulties or behavior which indicate the need for evaluation. |
| Actions Refused, with Explanations of Why Refused |
| Other Options Considered and reasons Why Rejected |
| Maintaining the current program with no interventions or adaptations.
REASONS REJECTED: Additional information is needed to determine eligibility, continued eligibility or current needs. |
| Basis for Determination |
| A review of existing data: previous evaluations, classroom-based assessments, observations, and information provided by parents. Classroom observations |
| Other Relevant Information |
| Your child is not progessing successfully. |
| Procedural Safeguards |
| You have protection under the procedural safeguards of the Individuals With Disabilities Education Act (IDEA). A copy of these procedural safeguards is being provided to you with this Prior Written Notice. |
If you are in need of assisstance in understanding the provisions of the special education education laws, or if you are interested in obtaining additional information, resources or support regarding the special education of your child, the following agencies may be of assistance:
*Arizona Department of Education/ESS: (602)
542-3184
*Parent Information Network Specialists:
(602) 5423184 or 1-800-352-4558
ADE/ESS & PINS: 1535 West
Jefferson, BIN #24, Phoenix, AZ, 85007
*Arizona Center for Disability Law (Phoenix):(602)
274-6287 or 1-800-922-1447
*Association for Retarded Citizens of AZ (ARC-Phoenix):
(602) 243-1787
*Central AZ. Council on Development Disabilities
(AJ): (480) 982-5015
*Department of Developmental Disabilities (AJ):
(480) 982-0018
*Learning Disabilities Association of Arizona
(Phoenix) : (602) 495-1175
*Superstition Mountain Mental Health Center (AJ)
: (480) 983-0571