Here's the referenced IEP Decleration Form:
DECLARATION OF FULL NAME
Full Name, hereby declares that the following statements are true and correct:
1. I am fully familiar with the facts stated in this Declaration.
2. I am the Title at School Name, a public school in District of Columbia.
3. I have been employed at School Name for approximately Number years or months (please circle).
4. As the Title at School Name, I coordinate and/or attend annual IEP meetings for students enrolled at School Name.
5. I am familiar with Student's Name (hereinafter “Student”).
6. An IEP meeting for the Student was held on Date or is scheduled to be held on Date (please circle).
7. As of October 5, 2010, I had provided Number minutes/hours (please circle) of specific special education service or related service to the Student as prescribed in the Student’s IEP since the beginning of the school year. That is, I provided Number hours of specific special education service or related service per week to the Student.
8. Since October 5, 2010, I have continued providing Number minutes/hours (please circle) of specific special education service or related service to the Student on a weekly basis.
I declare that the foregoing is true and correct.
Executed on ______________________