STATE SELPA TEMPLATE - San Mateo County Office of Education - smcoe 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date and the student's date of birth in the designated fields at the top of the form.
3. Fill in the student’s full name, including first, middle, and last names, ensuring accuracy for identification purposes.
4. Review the sections regarding proposed actions. Indicate whether you are consenting to or refusing changes related to identification, evaluation, educational placement, or provision of free appropriate public education.
5. In the description fields provided, clearly outline any proposed or refused actions along with reasons for these decisions. This is crucial for transparency and understanding.
6. Complete any additional information required about evaluation procedures and other options considered. This helps clarify your position and ensures all factors are documented.
7. Finally, provide your contact information at the bottom of the form to facilitate communication regarding this notice.

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