PWN/ARD IEP Supp

Student Name: April Test ID: TEST321323 Medicaid Number:

Houston Independent School District Office of Special Education Services
ARD/IEP SUPPLEMENT: Prior Written Notice
34 CFR §300.503 & 19 TAC §89.1050

Guidance: Prior Written Notice

What is Prior Written Notice?
Prior written notice contains the seven required items and meets state and federal requirements. Prior written notice is intended
to provide a clear record for the student, parent, and District of the decisions that have been or will be made, the basis for those
decisions, and the actions that will or will not be taken. Prior written notice records any proposals or refusals with regard to spe-
cial education matters.

Prior written notice must be provided in language understandable to the general public and in the native language of the adult
student/parent or other mode of communication used by the adult student/parent, unless it is clearly not feasible to do so. If the
native language/mode of communication of the adult student/parent is not a written language, the District must take steps to en-
sure that the prior written notice is translated orally or by other means to the adult student/parent in their native language/mode
of communication, ensuring that the adult student/parent understands the content of the prior written notice.

If prior written notice is provided after an ARD/IEP meeting, the adult student/parent has the right to use up to five days to re-
view documents, including a newly developed IEP, to make the most appropriate school-related decisions for himself/herself or
his/her child. In accordance with state and federal laws, HISD must wait 5 days to implement an IEP after the ARD/IEP meet-
ing. If the adult student/parent agrees to waive the 5 day waiting period, the IEP can be implemented immediately. The agree-
ment or disagreement is voluntary.

Prior Written Notice Is Also Needed When Agreement during An ARD/IEP Meeting Is Not Reached:
If, during an ARD/IEP meeting, the ARD/IEP Team does not reach mutual agreement, the adult student/parent will be offered
a single 10 day recess in order to allow the adult student/parent and the District the opportunity to reach mutual agreement. If
after the 10 day recess the ARD/IEP Team does not reach mutual agreement, the District shall provide an additional prior written
notice and may implement the IEP it determined to be appropriate for the child/adult student. However, a written statement of
the basis for the disagreement must be included in the IEP, and the parent who disagrees must be offered the opportunity to write
a statement of disagreement.

The District and the adult student/parent may request IEP facilitation by an independent facilitator under the Texas Education
Agency (TEA) program that provides IEP facilitators by completing and submitting the TEA’s required form within five days of
the ARD/IEP meeting that ended in disagreement.

The District may offer IEP facilitation, which is different from the TEA’s program that provides IEP facilitators, or may incorpo-
rate elements of IEP facilitation into an ARD/IEP meeting.

This prior written notice is provided to: 03/22/2022

Mike Test Date

Parent/Adult Student

Note: An adult student/parent may elect to receive the prior written notice by electronic mail.

Campus to Complete this Section

Identify and Describe the Action the District Will Take:
The District must provide prior written notice to the adult student/parent at least five school days, unless he/she agrees to a
shorter timeframe, before it:

Proposes or refuses to initiate or change the identification of the child/adult student
Proposes or refuses to initiate or change the evaluation of the child/adult student
Proposes or refuses to initiate or change the educational placement of the child/adult student
Proposes or refuses to initiate or change the provision of a free appropriate public education (FAPE) to the child/adult stu-
dent

Student Name: April Test ID: TEST321323 Medicaid Number:

Houston Independent School District Office of Special Education Services
ARD/IEP SUPPLEMENT: Prior Written Notice
34 CFR §300.503 & 19 TAC §89.1050

Ceases to provide special education and/or related services to the child/adult student due to adult student/parent’s revocation
of consent for services.
Implements an individualized education program (IEP) with which the parent/adult student disagrees.

Note: The District must provide the adult student/parent with prior written notice regardless of whether the adult student/parent
agreed to the change or requested the change.

Explanation of Action

1. Describe the action proposed/refused by HISD:

2. Explain why action was proposed/refused by HISD:

3. Describe each evaluation procedure, assessment record, or report HISD used/will use as a basis for the proposal/refusal:

4. Option(s) HISD considered/proposed and reason(s) option(s) refused:

5. Describe any other factors relevant to HISDs proposal/refusal:

Action When Evaluation is Requested
When an adult student/parent submits a written request to the District for an initial evaluation, the District must, not later than
the 15th day after the date of receipt, provide the parent/adult student:

· Prior written notice of its proposal to conduct an evaluation, a copy of the Notice of Procedural Safeguards, and an op-
portunity to give consent

· Prior written notice of its refusal to conduct an evaluation and a copy of the Notice of Procedural Safeguards

Campus Comment, if Applicable

Student Name: April Test ID: TEST321323 Medicaid Number:

Houston Independent School District Office of Special Education Services
ARD/IEP SUPPLEMENT: Prior Written Notice
34 CFR §300.503 & 19 TAC §89.1050

Parent/Adult Student to Complete This Section

Sources for parents/adult students to contact to obtain assistance in understanding the prior written notice provisions:
Houston ISD - Office Special Education Services

Phone: (713) 556-7025 Website: http://www.houstonisd.org/Page/58432

Dr. S. Lachlin Verrett,Executive Director, Special Education Services
Shawna Punch,Senior Manager, Special Education Services

Mary Kay Kinnett,Director for Speech-Language Services and Special Education Evaluations

Region IV Education Service Center Texas Workforce Solutions
7145 Tidwell Road Vocational Rehabilitation Services

Houston, Texas 77092, (713) 462-7708 6220 Westpark, Suite 110
www.esc4.net/specialeducation Houston, Texas 77057, (713) 267-8510

www.twc.state.tx.us

The Arc of Greater Houston Arc of Greater Houston - Familias Hispanas del Arc
3737 Dacoma, Suite E Spanish Support Group
4410 Navigation Blvd.
Houston, Texas 77092, (713) 957-1600
www.aogh.org Houston TX 77011, (713) 957-1600 ext. 117
Email Contact: [email protected]

Disability Rights, Texas Learning Disabilities Association of Texas
1500 McGowen St., Suite 100 P.O. Box 831392
Houston TX 77004, (713) 974-7691
Toll-Free Intake Line for New Callers: 1-800-252-9108 Richardson, TX 75083-1392
www.ldatx.org
www.disabilityrightstx.org
Email Contact: [email protected]

Special Kids, Inc. Texas Project First
9001 Airport Blvd., Suite 707 www.texasprojectfirst.org
Houston, Texas 77036, (713) 783-KIDS (5437) 1-855-SPEDTEX (1-855-773-3839)

www.specialkidsinc.com
Email Contact: [email protected]

Student Name: April Test ID: TEST321323 Medicaid Number:

Houston Independent School District Office of Special Education Services
ARD/IEP SUPPLEMENT: Prior Written Notice
34 CFR §300.503 & 19 TAC §89.1050

If you have questions regarding this notice, you may contact:

Special Education Senior Manager Program Specialist
Your signature below indicates that you understand the content of this Notice.

Parent/Adult Student Signature Date Interpreter/Translator Signature Date

Your signature below indicates that you waive the required five school days waiting period for the prior written notice.

Parent/Adult Student Signature Date Interpreter/Translator Signature Date

Parent/Adult Student Survey

Please participate in a brief survey to assist the Office of Special Education Services to provide quality services to students with
disabilities.

There are three ways to complete the survey:
1. Complete an online survey at your campus/your child’s school following an ARD/IEP meeting
2. Complete an online survey anytime at https://www.surveymonkey.com/s/HISD_Parent_Survey
3. Call us at (713) 556-7025 and we will mail you a survey to complete and return