"Prior Written Notice" - Georgia (United States)

Prior Written Notice is a legal document that was released by the Georgia Department of Education - a government authority operating within Georgia (United States).

Form Details:

  • Released on October 1, 2009;
  • The latest edition currently provided by the Georgia Department of Education;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Georgia Department of Education.

ADVERTISEMENT
ADVERTISEMENT

Download "Prior Written Notice" - Georgia (United States)

594 times
Rate (4.7 / 5) 36 votes
Prior Written Notice
Date: ____/____/____
Student Name: ________________________________________________
Birth date: ____/____/____ Parent(s): __________________________________________________
As a parent/adult student you have a right to receive written notice prior to when the school system
proposes or refuses to initiate or change the identification, evaluation, or placement of your child/you or
the provision of a free appropriate public education. You may also be receiving this if you have notified
the school system that you are removing your child/yourself from special education and related services.
Other documents, such as an IEP or an eligibility form may also include information for prior written
notice and may be referred to herein.
Purpose of this notice:
An action is being proposed
An action is being refused
Parent/adult student has notified system of revocation of consent to
receive special education and related services
1. A description of the action proposed or refused:
2. An explanation of why the system proposes or refuses to take the action:
3. A description of any other options the system considered and the reasons why those options were
rejected:
4. A description of each evaluation procedure, test, record, or report the system used as a basis for the
proposed or refused action:
5. A description of any other factors that is relevant to the system’s proposal or refusal:
If this proposed action is a change in identification, evaluation or placement, when will this action be
implemented? Date: ____/____/____
You and your child have the protections identified in the Parents Rights. If you need a copy of those rights
or if you have questions about any of this, please contact the following:
___________________________
___________________
_____________
________________
(Name)
(Position)
(Phone)
(E-mail)
Georgia Department of Education
October 2009
Prior Written Notice
Date: ____/____/____
Student Name: ________________________________________________
Birth date: ____/____/____ Parent(s): __________________________________________________
As a parent/adult student you have a right to receive written notice prior to when the school system
proposes or refuses to initiate or change the identification, evaluation, or placement of your child/you or
the provision of a free appropriate public education. You may also be receiving this if you have notified
the school system that you are removing your child/yourself from special education and related services.
Other documents, such as an IEP or an eligibility form may also include information for prior written
notice and may be referred to herein.
Purpose of this notice:
An action is being proposed
An action is being refused
Parent/adult student has notified system of revocation of consent to
receive special education and related services
1. A description of the action proposed or refused:
2. An explanation of why the system proposes or refuses to take the action:
3. A description of any other options the system considered and the reasons why those options were
rejected:
4. A description of each evaluation procedure, test, record, or report the system used as a basis for the
proposed or refused action:
5. A description of any other factors that is relevant to the system’s proposal or refusal:
If this proposed action is a change in identification, evaluation or placement, when will this action be
implemented? Date: ____/____/____
You and your child have the protections identified in the Parents Rights. If you need a copy of those rights
or if you have questions about any of this, please contact the following:
___________________________
___________________
_____________
________________
(Name)
(Position)
(Phone)
(E-mail)
Georgia Department of Education
October 2009