NOREP/PWN

Childs Name:

NOTICE OF RECOMMENDED EDUCATIONAL

PLACEMENT/PRIOR WRITTEN NOTICE (NOREP/PWN)

School Age13

Childs Name:
Lexi James
Date Sent (mm/dd/yy): 3/5/2015
Name and Address of Parent/Guardian/Surrogate:
Ms. Linda James

For LEA Use Only:

Date of Receipt of Signed
NOREP/PWN

123 Apple Road

Apple, PA 12345

Dear

Ms. James

This is to notify you of the Local Education Agencys (LEAs) action regarding your childs educational program.
1. Type of action taken:
Proposes initial provision of special education and related services (For this action, the school may not
proceed without your written consent in Section 8 of this document)
Refusal to initiate an evaluation (Must issue Procedural Safeguards Notice)
Proposes to change the identification, evaluation or educational placement of the child or the provision of
a free appropriate public education (FAPE)
Refusal to change the identification, evaluation or educational placement of the child or the provision of
a free appropriate public education (FAPE)
Change of placement for disciplinary reasons (Must issue Procedural Safeguards Notice)
Due process hearing, or an expedited due process hearing, initiated by LEA
Graduation from high school
Exiting special education
Exiting high school due to exceeding the age eligibility for a free appropriate public education (FAPE)
Extended School Year (ESY) services
Response to request for an independent educational evaluation (IEE) at public expense
X

Other
-Continuation of services.

2. A description of the action proposed or refused by the LEA:

The action proposed by the LEA is for Lexi to stay in her current placement. Lexi is in the general
education curriculum for all subjects except math. She receives Supplemental Math 5x a week and
receives Academic Support 3X a week.
3. An explanation of why the LEA proposed or refused to take the action:
The LEA proposed a supplemental math class because it provides the student with a sufficient level of
instruction, and accommodations in her least restricted environment that will enable the student to
progress and receive a free and appropriate public education. The LEA proposed Academic Support
because it provides the student with executive functioning support.
4. A description of other options that the IEP team considered and the reasons why those options were
rejected. If the action proposed or refused is in regard to educational placement, options considered must
begin with the regular educational environment with supplementary aids and services (information about
supplementary aids and services is available on the PaTTAN website at www.pattan.net):
Options Considered
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Reason for Rejection

October 2014

NOREP/PWN
Childs Name:
Itinerant Support
Dismissal from Special Education

Student needs additional support. Not

recommended at this time.
Not recommended at this time.

5. A description of each evaluation procedure, assessment, record or report used as a basis for the proposed
action or action refused:
The re-evaluation report, professional observations, parental input, and curricular data indicate that
Lexi is eligible for specially designed instruction that can best be provide through supplemental math
and academic support.
6. A description of other factors that were relevant to the LEAs proposal or refusal:
Parental input and supplemental information that is pertinent to the students educational program.
7. The educational placement recommended for your child is (State the amount and type of special education
supports, e.g., Itinerant Learning Support, Supplemental Autistic Support, Full-Time Emotional Support):
Supplemental Math Class and Academic Support
School District Superintendent/Designee
Charter School CEO

Signature

Date
(mm/dd/yy)

You have rights and protections under the law described in the Procedural Safeguards Notice. If you need
more information or want a copy of this notice, please contact:
Name and Title:
Phone:
Email Address:
8. PARENTAL CONSENT
Directions for Parent/Guardian/Surrogate: Please check one of the options, sign this form, and return it
within 10 calendar days. In circumstances when this form is NOT completed and parental consent is NOT
required, the school will proceed as proposed after 10 calendar days.
I request an informal meeting with school personnel to discuss this recommendation.
I approve this action/recommendation.
I do not approve this action/recommendation.* My reason for disapproval is:

I request (Contact the Office for Dispute Resolution at 800-222-3353 for information on Mediation
and Due Process Hearing):
Mediation
Due Process Hearing
* Except for placement in an interim alternative educational setting due to drugs, weapons, or serious
bodily injury (300.530(g), 300.530(i), and 300.531), if you do not approve the action/recommendation,
your child will remain in the current program/placement only if you request a due process hearing or
mediation through the Office for Dispute Resolution. If you do not request Due Process or Mediation
through the Office for Dispute Resolution, the LEA will implement the action/recommendation.
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October 2014

NOREP/PWN
Childs Name:

SIGN HERE:
Parent/Guardian/Surrogate Signature

Date (mm/dd/yy)

Daytime Phone

PLEASE RETURN THIS ENTIRE FORM TO:

School District of Apple Township
Name:
Address
50 East Eagle Road
:
Apple, PA 19083

Attached are state and local resources you can consult to help you understand your rights and how the special
education process works.
For help in understanding this form, an annotated NOREP/Prior Written Notice is available on the PaTTAN
website at www.pattan.net Type Annotated Forms in the Search feature on the website. If you do not have
access to the Internet, you can request the annotated form by calling PaTTAN at 800-441-3215.

Page 3 of 4

October 2014

RESOURCES
NOREP/PWN
Childs Name:

RESOURCES
THE ARC OF PENNSYLVANIA
301 Chestnut Street, Suite 403
Harrisburg, PA 17101
800-692-7258
www.thearcpa.org
BUREAU OF SPECIAL EDUCATIONS CONSULTLINE,
A PARENT HELPLINE
800-879-2301
ConsultLine personnel are available to parents and
advocates of children with disabilities or children
thought to be disabled to explain federal and state
laws relating to special education; describe the
options that are available to parents; inform the
parents of procedural safeguards; identify other
agencies and support services; and describe
available remedies and how the parents can
proceed.
DISABILITIES RIGHTS NETWORK
1414 North Cameron Street
Suite C
Harrisburg, PA 17103
800-692-7443 (Toll-Free Voice)
877-375-7139 (TDD)
717-236-8110 (Voice)
717-346-0293 (TDD)
717-236-0192 (Fax)
www.drnpa.org
HISPANOS UNIDOS PARA NIOS
EXCEPCIONALES (PHILADELPHIA HUNE, INC.)
2215 North American Street
Philadelphia, PA 19133
215-425-6203
215-425-6204 (Fax)
[email protected]
www.huneinc.org
MISSION EMPOWER
1611 Peach Street, Suite 120
Erie, PA 16501
814-825-0788
[email protected]
www.missionempower.org

Page 4 of 4

OFFICE FOR DISPUTE RESOLUTION

6340 Flank Drive
Harrisburg, PA 17112-2764
717-901-2145 (Phone)
800-222-3353 (Toll free in PA only)
TTY Users: PA Relay 711
717-657-5983 (Fax)
www.odr-pa.org
The Office for Dispute Resolution administers the
mediation and due process systems statewide, and
provides training and services regarding
alternative dispute resolution methods.
PARENT EDUCATION AND ADVOCACY LEADERSHIP
CENTER (PEAL)
1119 Penn Avenue, Suite 400
Pittsburgh, PA 15222
412-281-4404
866-950-1040 (Toll Free)
412-281-4409 (TTY)
412-281-4408 (Fax)
www.pealcenter.org
PUBLIC INTEREST LAW CENTER OF PHILADELPHIA
United Way Building
1709 Benjamin Franklin Parkway, Second Floor
Philadelphia, PA 19103
215-627-7100 (Phone)
215-627-3183 (Fax)
www.pilcop.org
PENNSYLVANIA BAR ASSOCIATION
100 South Street
Harrisburg, PA 17101
800-932-0311
www.pabar.org
THE PENNSYLVANIA TRAINING AND TECHNICAL
ASSISTANCE NETWORK (PaTTAN)
Harrisburg 800-360-7282
King of Prussia 800-441-3215
Pittsburgh 800-446-5607
www.pattan.net
STATE TASK FORCE ON THE RIGHT TO EDUCATION
3190 William Pitt Way
Pittsburgh, PA 15238
1-800-446-5607 ext. 6828

October 2014