Special Education Evaluation and Reevaluation Consent Form

Obtains parent or guardian consent before an initial special education evaluation or reevaluation and documents receipt for IDEA timeline tracking.

Submission Purpose

• What are you consenting to?
• Date consent is submitted
  This date is used to document receipt and support IDEA timeline tracking.
• Consent acknowledgment

Student Information

• Student full name
• Student ID
  Optional if your district uses another unique identifier.
• Student date of birth
  Collect only if needed to distinguish the student from others with a similar name.
• School

Parent or Guardian Information

• Parent or guardian name
• Relationship to student
• If other, describe relationship
• Email address
  Optional. Used for sending a copy of the consent record or follow-up communication.
• Phone number
  Optional. Used only if the team needs to clarify the consent record.

Evaluation Consent Details

• Areas to be evaluated
• If other, describe additional evaluation area(s)
• Consent scope
• Describe any limitations on consent

Consent and Disclosure

• Consent statement
• PII and records acknowledgment
• Questions or concerns
  Optional. Use this space to note any questions about the evaluation process or consent limitations.

Signature and Submission

• Electronic signature
• Signature date
• How should a copy of this consent be delivered?