PARENT

12 TANGIPAHOA PARISH SCHOOL SYSTEM SCREENING/ASSESSMENT CONSENT FORM

Dear Parent/Guardian:

Tangipahoa Parish School System, in compliance with Bulletin 1903 [R. S. 17:7 (11) (B)], will provide an initial screening for every child in grades k – 3, at least once, for dyslexia and related disorders, ADHD, and social and emotional “at risk” factors. In order to fulfill its obligation under Section 504, the school system recognizes a responsibility to avoid discrimination in policies and practices regarding its students.

Signed consent will allow screening, and assessment if needed, at school, for the entire period a student is enrolled in any public school in the Tangipahoa Parish School System. Consent may be rescinded in writing at any time. Please return this form to the homeroom teacher.

I understand that if this consent is not signed, the student named below will not be screened.

Student:______Date:______

Parent/Guardian Signature:______

YES _____ Tangipahoa Parish School System has my permission to provide an initial screening for dyslexia and related disorders, ADHD, and social and emotional “at risk” factors.

NO _____ Tangipahoa Parish School System does not have my permission to provide an initial screening for dyslexia and related disorders, ADHD, and social emotional “at risk” factors.

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“The Tangipahoa Parish School System does not discriminate on the basis of race, color, national origin, sex, age, disabilities or veteran status. We are an equal opportunity employer.” Parent/Student Rights in Identification, Evaluation and Placement Section 504 of the Rehabilitation Act of 1973

The following is a description of the rights granted by federal law to students with disabilities. The intent of the law is to keep you fully informed concerning decisions about your child and to inform you of your rights if you disagree with any of these decisions. You have the right to:

 Have your child take part in and receive benefits from public education programs without discrimination because of his/her disabling condition;

 Have the school district advise you of your rights under federal law;

 Receive notice with respect to identification, evaluation, or placement of your child;

 Have your child receive a free appropriate public education. This includes the right to be educated with non-disabled students to the maximum extent appropriate to the needs of the disabled student. It also includes the right to have the school system make reasonable accommodations to allow your child an equal opportunity to participate in school and school-related activities;

 Have your child educated in facilities and receive services comparable to those provided non-disabled students;

 Have your child receive specially designed education and related services if she is found to be eligible under the Individuals with Disabilities Education Act;

 Have transportation provided to and from an alternative placement setting at no greater cost to you than would be incurred if the student were placed in a program operated by the district;

 Have the interpretation evaluation data and placement decisions based upon a variety of information sources and placement decisions made by persons who know the student, the meaning of the evaluation data, and placement options;

 Have your child provided with an equal opportunity to participate in nonacademic and extracurricular activities offered by the system;

 Examine all relevant records relating to decisions regarding your child’s identification, evaluation, education program, and placement;

 Obtain copies of educational records at a reasonable cost unless the fee would effectively deny you access to the records;

 A response from the school system to reasonable requests for explanations and interpretations of your child’s records;

 Request amendment of your child’s educational records if there is reasonable cause to believe that they are inaccurate, misleading, or otherwise in violation of the privacy rights of your child. If the school system refuses this request for amendment, it shall notify you within a reasonable time and advise you of the right to a hearing;

 Request and participate in a review or an impartial hearing, with counsel if desired, related to decisions or actions regarding your child’s identification, evaluation, educational program or placement;

14  Request payment of reasonable attorney fees if you are successful on your claim;

 File a local grievance.

The person at the school who is responsible for Section 504/ADA compliance is the building principal. The District Section 504 Coordinator may be contacted at the TPSS Central Office, 59656 Puleston Road, Amite, LA 70422, (985) 748-2477. Tangipahoa Parish School System Section 504 Parent Notification/Oral Interpretation

Student: ______SS/ID#:______Date:______

School: ______Grade:______Teacher:______

Dear: ______The Section 504 committee has scheduled a meeting concerning your child for the reason(s) indicated below. ______Section 504 Evaluation/Re-evaluation and Oral Interpretation ______Section 504 Individual Accommodation Plan and Oral Interpretation ______Act 1120 Screening/Assessment Oral Interpretation ______Section 504 Manifestation Determination Relatedness Hearing

______Section 504 Student Accommodation Refusal Your attendance at this meeting will be greatly appreciated.

DATE: ______

TIME: ______

PLACE: ______

Sincerely,

______Section 504 Chairperson

______Parent did not attend meeting and a copy was mailed on ______. OR ______The Section 504 Evaluation/Re-evaluation and/or Individual Accommodation Plan and/or the Act 1120 Screening for my child has been explained to me. I understand the oral explanation and the written plan has been provided to me. I retained a copy of the plan.

______

15 Parent/Guardian Signature Date

______Section 504 Chairperson Date

______Parent/Student Rights Attached Tangipahoa Parish School System Multisensory Structured Language Program Parent Notification/Oral Interpretation

Student: SS/ID #:

School: Grade:

The School Building Level Committee (SBLC/504) at your child’s school has determined that your child demonstrates characteristics of Dyslexia and would benefit from a Multisensory Structured Language Program. Teachers have been trained to administer these assessments and render recommendations based on the results. This is not a formal diagnosis or analysis.

Dyslexia is defined under the Louisiana Law for the Education of Dyslexic Students as “a language processing disorder which may be manifested by difficulty processing expressive or receptive, oral or written, language despite adequate intelligence, educational exposure, and cultural opportunity. Specific manifestations may occur in one or more areas, including difficulty with the alphabet, reading, comprehension, writing, and spelling.”

A meeting has been scheduled for oral interpretation of the Dyslexia Assessment. Your attendance at this meeting will be greatly appreciated.

DATE:

TIME:

PLACE:

Sincerely,

SBLC/504 Chairperson

Parent did not attend meeting and a copy was mailed on ______. OR The Dyslexia Assessment for my child has been explained to me. I understand the oral explanation and a copy of the assessment has been provided to me.

Parent/Guardian Signature Date

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SBLC/504 Chairperson

Parent/Student Rights Attached

Tangipahoa Parish School System Section 504 Student Accommodation Refusal

Student’s Name:______Date:______Grade:______

School:______I. D. #:______

Teacher:______Principal:______

The student and parent must sign this form if student chooses not to accept accommodations as specified on the Section 504 - Individual Accommodation Plan and Test Verification Form.

Student

I understand that my parent/guardian will be notified and must approve of my decision by signing this form. I select not to accept class and test accommodations as recommended by the Section 504/Student Assistance Team.

I, ______, will not accept the (student’s signature) accommodations as specified on my Individual Accommodation Plan.

______(date)

Parent/Guardian

The parent/guardian must sign acknowledging and approving the student’s decision.

I am the parent/guardian of ______. (student’s name) I approve of the student’s decision not to accept accommodations as

specified on his/her Section 504 Individual Accommodation Plan. I reserve

the right to request a Section 504 Reassessment.

______(parent/guardian signature) (date)

17 Signature of Witnesses:

______Principal or Assistant Principal Date Section 504 Chairperson Date Revised 3-5-08

TANGIPAHOA PARISH SCHOOL SYSTEM Section 504 Parent/Guardian Notification of Ineligibility

______(date)

TO: Parent: ______

Address: ______(street / p. o. box)

______(city) (state) (zip)

FROM: Section 504 Chairperson: ______

Principal: ______

School: ______

SUBJECT: Section 504 Ineligibility

You were invited to a meeting on ______. Courtesy has been extended and a copy of the reassessment is attached. Your child, ______, has been reassessed and eligibility for 504 accommodations has ended. An annual review is no longer needed. The student may be reconsidered for eligibility at any time through the Student Assistance Team process.

18 “ The Tangipahoa Parish School System does not discriminate on the basis of race, color, national origin, sex, age, disabilities or veteran status. We are an equal opportunity employer.”

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