Education Plan Review Consent Attendance

EDUCATION PLAN REVIEW CONSENT & ATTENDANCE

Student Name:    Student ID:

Date of Birth:    Grade/Program:

School / District Information

Planned Meeting Details

Meeting Purpose:

Meeting Date: Month Day Year    Time:

Location:

Attendees & Participation

Please list expected attendees and their role. If additional attendees will join, indicate authorization in the comments below.

Meeting Format & Consent Options

Meeting Mode: In-person Remote (video) Telephone

I consent to the school providing copies of relevant educational records described above to attendees for the purposes of this review: Yes No

I consent to the meeting being audio or video recorded for the purpose of accurate record-keeping and implementation of the education plan: Yes No

If a parent/guardian or adult student cannot attend, do you authorize the meeting to proceed with the identified school representatives in your absence? Yes No

Accommodations, Medical & Emergency Information

Acknowledgment & Certification

By signing below I acknowledge that I have been notified of the scheduled education plan review meeting, that the purpose of the meeting and the documents to be reviewed have been described above, and that I understand the meeting will address current progress, goals, accommodations, services, and placement recommendations as applicable. I understand that information discussed may be shared with authorized attendees for the limited purpose of plan development and implementation, and will be handled in accordance with applicable education privacy laws.

I certify that I am the parent/legal guardian of the student identified above, or I am the student and am legally competent to provide consent. I understand that I may revoke any consent provided herein in writing, subject to any records already generated or actions already taken in reliance on this consent.

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