E-2 Prior Written Notice & Consent for Evaluation

School District/Public Agency Lincoln County School District #1

Prior Written Notice & Consent for Evaluation

34 C.F.R. 300.300 300.305
ID 98967703 DOB 5/28/2004 Grade 04 Date 11/11/2013

Name of Student Kymberlee Scroughams

A. The team is proposing the following:

Indicate the type of evaluation. To evaluate your child for initial special education eligibility. 34 C.F.R. 300.300(a) To reevaluate your child for the continued need for special education and related services. 34 C.F.R. 300.300(c) (An evaluation after the initial evaluation.) To reevaluate your child before a change in eligibility. 34 C.F.R. 300.305(e)

B. Based on the review of existing information: Complete section 1 or 2.

1. No additional assessment data are needed. 34 C.F.R. 300.305(a) and (d) No additional assessment data are needed to determine if your child is or continues to be eligible for special education services or to determine your childs educational needs. (If the parent disagrees, the parent may request additional assessment.) Reasons: If the team determines no additional data are needed, the evaluation is complete, and your informed consent is not necessary. 2. Additional assessment data are needed. 34 C.F.R. 300.305(a) The team has determined that additional assessment data are necessary to determine if your child is or continues to be eligible for special education services or to determine your childs educational needs. (If this box is checked, use page 3 to obtain informed consent.) Identify the areas the team proposes to assess. 34 C.F.R. 300.304 Academic Performance Communication Skills General Intelligence Functional Behavior Adaptive Behavior Social, Emotional Assistive Technology Describe the proposed assessment process. The IEP team would like to reassess Kymberlee's cognitive and academic abilities, behavior, and speech and language skills. The assessments that will be used include: WISC, WCJ III, BASC, IRI, Artic and Language Eval. Health Vision Motor Skills Hearing Postsecondary Transition Needs Other social, emotional, behavioral

WDE Model Form E-2 Adopted 05/02/2011 Page 1 of 3

E-2 Prior Written Notice & Consent for Evaluation

C. Prior Written Notice:

The school district must give you a written notice whenever the school district: (1) Proposes to initiate or change the identification, evaluation or educational placement of your child or the provision of a free appropriate public education (FAPE) to your child; or (2) Refuses to initiate or change the identification, evaluation or educational placement of your child or the provision of FAPE to your child. You and your child are entitled to procedural safeguards under the Individuals with Disabilities Education Act (IDEA). A copy of the Notice of Procedural Safeguards can be obtained from your childs school or the WDE website at www.edu.wyoming.gov. It contains a list of resources for parents to obtain assistance in understanding the IDEA. Written Notice of Special Education Action. 34 C.F.R. 300.503 Description of the action the school district or public agency proposes or refuses to take: The IEP team would like to reevaluate Kymberlee. Explanation of why the school district or public agency is proposing or refusing to take that action: The IEP team would like to reevaluate Kymberlee to get a better idea as to how she learns best, and where she is academically. Description of each evaluation procedure, assessment, record, or report the school district or public agency used as a basis for the proposed or refused action: The IEP team looked at Kymberlee's informal and formal classroom assessments, MAPS scores, informal reading inventory, current grades, and cumulative records from Rigby Idaho School District #251. Description of any other options the Team considered and the reasons why those choices were rejected: The IEP team discussed not testing Kymberlee at this time. This was rejected because the preexisting data no longer supports Kymberlee's current abilities as measured by her informal and formal classroom assessments, MAPS scores, and informal reading inventory. Description of other relevant factors: Kymberlee transferred into Kemmerer Elementary from Rigby Idaho on September 17, 2013.

WDE Model Form E-2 Adopted 05/02/2011 Page 2 of 3

E-2 Prior Written Notice & Consent for Evaluation

CONSENT OR REFUSAL FOR EVALUATION

Name of Child Kymberlee Scroughams

Date 11/11/2013

Please sign, date and return this page as soon as possible.

I have received information relevant to the proposed evaluation of my child. I have read the form and enclosed materials. Please check one box below to indicate your preference : I CONSENT to the evaluation. I REFUSE consent for the evaluation.

Parent Signature

Date

Joyce Johnson 11/11/2013 ******************************************************************************************** For School District or Public Agency Use Date received by the school district or public agency: Date received Signature of School District or Public Agency Official 11/11/2013 Danielle Rosa

WDE Model Form E-2 Adopted 05/02/2011 Page 3 of 3