Prior Written Notice FormInformative Image: Sample Form
Long Description: Screen shot showing page 1 of the Prior Written Notice Form
Slide 9: Prior Written Notice Form
This slide, and the following slide, have been included in this presentation to show you what the prior written notice form looks like. These two slides show the same form as found in Attachment 1, the prior written notice form itself, which is posted on the Department website (referenced in Slide 5 of this presentation).
The prior written notice form is in a letter format and includes:
identifying information including:
date of notice,
parent name and address, and
student’s name, date of birth and local identification # (if used by the district);
an introductory paragraph informing the parent or guardian of the purpose of the notice;
the subject of the notice; and
information required to be included in prior written notice (referenced in slide 9 of this presentation).
The form includes expandable text boxes where the district must add appropriate information.
It also includes several drop-down options for the subject of the notice and a text box for the district to enter any other subject not included in the drop-down list of options.
Districts should place the prior written notice on the school district’s letterhead.