IEP Service Decleration Form

Dear colleagues, did you receive the WTU message about the IEP Service Decleration Form? If not, here it is...

IEP SERVICE DECLARATION FORM

The Washington Teachers’ Union (WTU) has reached an agreement with the Office of the State Superintendent of Education (OSSE) and DC Public Schools (DCPS) that will now allow service providers to sign the IEP Service Declaration Form. Both OSSE and DCPS have agreed to the removal of the Penalty of Jury language from the form as requested by the WTU. A copy of the revised form has been forwarded to your WTU email account. The WTU now recommends that our Service Providers complete and sign the IEP Service Declaration Form. Thank you for your patience while the WTU worked to resolve this issue in a manner that protects the rights and interests of our members.

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 ______________________
                                   Date



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                    Full Name



__________________________________
                          Title