"Revocation of Consent for the Provision of Special Education and Related Services" - Georgia (United States)

Revocation of Consent for the Provision of Special Education and Related Services 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;
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Revocation of Consent for the Provision of Special
Education and Related Services
Date: ____/____/____
Dear School System:
We /I no longer want our/my child,___________________________, to receive special education and
related services. We are providing you this notice to inform you that we want to remove our child from all
special education and related services.
I am a student who is 18 years or older, and have had my rights regarding special education and related
services transferred to me. I am revoking consent for special education and related services, I no longer
wish to receive any special education and related services.
By revoking consent for the provision of special education and related services, we/I acknowledge the
following:
1. I understand that my child will be considered a general education student, my child’s rights to
special education and related services will end, and my parental rights in special education will end.
2. I understand that should my child be involved in a major disciplinary situation my child would not
receive the special education protections previously available.
3. I understand that the school system is not required to amend my child’s records to remove any
references to my child’s receipt of special education and related services.
4. I understand that the school system may not use the dispute resolution (mediation/due process
hearings) options to challenge my right to discontinue services to my child.
5. I understand that the school system will not be considered in violation of the requirement to
provide a free, appropriate public education (FAPE) to my child because of the failure to provide my
child with further special education and related services.
6. I understand that the school system is not required to conduct reevaluations, convene an IEP
meeting, or develop an IEP for my child. Any future request for evaluation will be considered a
request for an initial evaluation, subject to the 60 day timeline.
7. I understand that my child will no longer receive special education and related services as of the
date the school system states in its prior written notice.
I revoke consent for all special education and related services for my child/myself.
We/
____________________________________________________________
____/____/____
Parent/guardian/adult student signature
Date
Georgia Department of Education
October 2009
Revocation of Consent for the Provision of Special
Education and Related Services
Date: ____/____/____
Dear School System:
We /I no longer want our/my child,___________________________, to receive special education and
related services. We are providing you this notice to inform you that we want to remove our child from all
special education and related services.
I am a student who is 18 years or older, and have had my rights regarding special education and related
services transferred to me. I am revoking consent for special education and related services, I no longer
wish to receive any special education and related services.
By revoking consent for the provision of special education and related services, we/I acknowledge the
following:
1. I understand that my child will be considered a general education student, my child’s rights to
special education and related services will end, and my parental rights in special education will end.
2. I understand that should my child be involved in a major disciplinary situation my child would not
receive the special education protections previously available.
3. I understand that the school system is not required to amend my child’s records to remove any
references to my child’s receipt of special education and related services.
4. I understand that the school system may not use the dispute resolution (mediation/due process
hearings) options to challenge my right to discontinue services to my child.
5. I understand that the school system will not be considered in violation of the requirement to
provide a free, appropriate public education (FAPE) to my child because of the failure to provide my
child with further special education and related services.
6. I understand that the school system is not required to conduct reevaluations, convene an IEP
meeting, or develop an IEP for my child. Any future request for evaluation will be considered a
request for an initial evaluation, subject to the 60 day timeline.
7. I understand that my child will no longer receive special education and related services as of the
date the school system states in its prior written notice.
I revoke consent for all special education and related services for my child/myself.
We/
____________________________________________________________
____/____/____
Parent/guardian/adult student signature
Date
Georgia Department of Education
October 2009