Geneva City School District Office of Student Services
SAMPLE Student Services Consent for Initial Evaluation
Below is a sample of the form a parent/guardian would be asked to sign
I have received and understand the notice that my child has been referred to the Committee on Special Education for evaluation to determine if my child has a disability that may require special education services. I understand that I must give written consent to the district in order for my child to be evaluated.
I have also received a copy of the Procedural Safeguards Notice.
Please check one box:
□ I hereby grant consent for evaluation by the Committee on Special Education as indicated below:
□ I do not consent for evaluation by the Committee on Special Education.