Notice of Special Education Record Retention Provide this notice to the parent or eligible student: 1. when the student is dismissed from special education 2. at the last IEP meeting prior to graduation 3. at the last IEP meeting prior to aging out of special education Student Name: School: Date of Notice: Dear All elements of your/your child’s special education record will remain intact for five years after your/his/her 21st birthday. At that time, the contents will be destroyed with the exception of the last IEP, all Evaluation Reports, last Prior Written Notice and Parent Consent/Objection form, and Summary of Performance (if services were provided until graduation or until the student aged-out). You maintain the right to request that records be destroyed immediately following graduation. However, the district may, without time limitation, maintain a permanent record of the student’s name, grades, address, phone number, attendance, classes attended, grade level completed and year completed for its own records based upon federal law. Destruction includes physical destruction (i.e., shredding) or removal of personal identifiers.

Eligible Student/Parent Response I understand this constitutes my notification prior to destruction of my/my child’s special education records. No further notice will be given.

Signature of parent or eligible student

Case managers: • Attach a Procedural Safeguards Notice • Place a copy of this notice in the Student’s Due Process Folder

Date