EIP Transition Guidance - Appendix E - Summary of Parent Consents and Sample Parent Consent Forms
Summary of Parent Consents
| Parent Consent Requirement | Date Requested | Date Received |
|---|---|---|
| Written consent to notify the school district in which the child resides of the child's potential eligibility for services under Section 4410 of the Education Law (notification must be completed at least 120 days prior to the date the child is first eligible for such services). 10 NYCRR 69-4.20(b) | ||
| Written consent for the Early Intervention Official to arrange for a transition conference (the transition conference must be convened at least 90 days prior to the date the child is first eligible for services under Section 4410 of Education Law or the child's third birthday, whichever is first). 10 NYCRR 69-4.20(b)(3) | ||
| Written consent to refer the child to the Committee on Preschool Special Education, in the school district where the child resides. | ||
| Written consent for evaluation of the child by the CPSE. Part 200.5(b)(1)(i) | ||
| Written consent to allow the service coordinator to forward evaluation and other EIP records for review by the CPSE, to assist in completion of the child's evaluation by the CPSE. 10 NYCRR 69-4.20(b)(2) 3 | ||
| Written consent to incorporate the transition plan into the IFSP. 10 NYCRR 69-4.20(a)(2)(iii) | ||
| Written consent for the IEP. Part 200.16(g)(7)(Part 200.5(b)(1)(ii) | ||
| If the child will continue in the EIP, written consent to continue the services in the IFSP until the child is no longer age eligible, or until the date at which the parent elects to transition the child, if earlier. 10 NYCRR 69-4.11(a)(8) | ||
| Written consent to notify the school district that the child will remain in the EIP until the child ages out. 10 NYCRR 69-4.20(d) | ||
| Written consent to transmit EIP records to providers of preschool special education programs and services, at the time the child transitions to these services. 10 NYCRR Section 69-4.17(c)(5) 4 |
3 Parents have the right to sign either a general release or selective release, which specifies by name or category those individuals to whom information may be disclosed.
4 Parents have the right to choose which records and reports, if any, are transmitted to the CPSE.
Sample Consent Forms
- Sample Consent Form for Transition Notice (PDF, 100KB, 1pg.)
- Sample Consent Form for Transition Conference (PDF, 100KB, 1pg.)
- Sample Consent Form for Referral to the Committee on Preschool Special Education (PDF, 101KB, 1pg.)
- Sample Consent Form for Transmittal of EIP Evaluations and Records to the CPSE (PDF, 100KB, 1pg.)
