Refusal of Resource Services - Trinity Christian Academy

Hidden

Date Submitted

Parent/Guardian Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Student Name(Required)

First Last

Student Grade(Required)

Parent Acknowledgement

As the parent or legal guardian of the above reference student please choose one of the following:

With my signature below, I understand that, if at any time, I change my mind and request my student to begin special education services, the Resource Department, with the approval of Administration, will conduct appropriate assessment and convene an AIP meeting or parent teacher conference to begin services.

With my signature below I also understand that my student will be placed on a one semester probationary period. Administration reserves the right to call a parent AIP meeting and/or Parent Teacher conference, if the student is not making academic progress and requires resource service support.

Signature(Required)