Master Agreement 2005 - State Employment Relations Board

IEP FormforAppeal
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COLUMBUS PUBUC SCHOOLS
SPECIAL EDUCATION. J.E.P. APPEAL
School Date Submitred
Teacher Spec. Education Program
.,
Date of entry to the class
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Student's Name Date of Birth
State specific reasons which formed the basis for the objection:
Recommendation:
(Optional)
Teacher's Signature Date
Sign and date below and forward to the appropriare Special Education Supervisor within three (3)
days of receipt.
Principal's Signature Date
Date Received Conference Date
Disposition
(must occur within 15 school days)
Supervisor's Signature Date
To the Principal:
Forward this request to the Director of Special Education.
State objection to Supervisor's disposition:
Recommendation:
(Optional)
Thacher's Signature Date
Date Received Conference Date
Disposition:
(must occur within 15 school days)
Director's Signature Date
Wh ite: Teacher Yellow: SpecieiEducation Pink.: Principal
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