No Response on Consent to Evaluate and Form
[LETTERHEAD]
January 19, 2018
[PARENTS]
[ADDRESS]
[CITY, STATE ZIP]
Re: [STUDENT NAME]
Dear [PARENTS]:
On (date) our school district sent you permission forms requesting your consent for the school to determine whether your child has a disability and is therefore eligible for an assistance plan under Section 504 of the Rehabilitation Act. We have not received a response from you to that request.
When a parent fails to respond to a request for consent to such an assessment, the school district is prohibited from treating the student as if he/she has a disability. Therefore, the school district will consider your student to be a general education student subject to the academic and disciplinary rules of the general education population.
Should you wish to discuss this matter further, please contact me at _____________. I have enclosed a copy of a document that outlines your rights as a parent of a student who may have a disability.
Yours very truly,
[NAME], [POSITION]
[SCHOOL DISTRICT]
Enclosure
Consent to Evaluate Under Section 504 of the Rehabilitation Act
School: _________________________
Date:_____________________
Student Name: ___________________________________
Date of Birth:____________ Age: ________
Grade: ___________
Parent/Guardian Name(s): _________________________________ _________________________________ _
I DO ____ DO NOT ____ consent to the assessment of my child to determine whether he/she qualifies as a student with a disability under Section 504 of the Rehabilitation Act. I understand that my consent may be revoked at any time prior to the completion of this assessment.
Parent or Guardian Signature: __________________________ Date:________________
*Please return this document to the school district
FOR SCHOOL DISTRICT USE ONLY:
Received by: _________________________
Date: ______________
