ࡱ> Z\Yb jbjb $Xmm ^^^8lkxTTTTnH,R5]BBBnTT4%nnnBTTnBnnn *^Rnn,;0knnnn ^^ Student s Name:  FORMTEXT      DOB: FORMTEXT       Grade:  FORMTEXT     Parent/Guardian Name(s):  FORMTEXT       Address:  FORMTEXT       Home Phone: ( FORMTEXT    )  FORMTEXT       Cell: ( FORMTEXT    ) FORMTEXT       Work Phone: ( FORMTEXT    ) FORMTEXT       District where private school is located : FORMTEXT       District of Residence:  FORMTEXT       Home School:  FORMTEXT       Private School:  FORMTEXT       Private School Phone: ( FORMTEXT    ) FORMTEXT       District of Residence Phone: ( FORMTEXT    ) FORMTEXT       ( Check one of the following  FORMCHECKBOX  Student s parents have declined the district s offer of a Service Plan. OR  FORMCHECKBOX  Students parents have accepted the districts offer of a Service Plan. Services: The District (LEA) will provide the special education service(s) below for the student while enrolled in private school or until the proportionate share of federal funds have been expended for the current school year. Area(s) of need: FORMTEXT       Levels:  FORMTEXT       Special Education ServiceFrequencyDurationLocationStart DateEnd DateService Provider FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT        FORMCHECKBOX  Student has been found eligible for special education services. By signing this document, the parent/guardian(s) have indicated to the District of Residence (DOR) that they have chosen to unilaterally enroll or continue to enroll the student in a private school without the consent of, referral by, or at expense of the District. It is further acknowledged that the DOR has offered to develop an IEP when the students parent/guardian(s) express an interest in enrolling the student in public school. The parents understand in accordance with IDEA 2004, their rights to due process do not apply in the private school setting. Parent:_____________________________________Date:_____ / _____ / _____LEA Representative:_____________________________________Date:_____ / _____ / _____Other_____________________________________Date:_____ / _____ / _____ Next Annual Review Due By: FORMTEXT      Triennial Review Due By: FORMTEXT           Sonoma County Special Education Local Plan Area SERVICE PLAN FOR PARENTALLY PLACED PRIVATE SCHOOL STUDENTS SELPA 29 10/09 "$8:<FHPRfhjtvƮӗӗgӗWh|Th3x>*CJOJQJaJ.jh|Th3x>*CJOJQJUaJ.jth|Th3x>*CJOJQJUaJ-jh3x>*CJOJQJUaJmHnHu.jh|Th3x>*CJOJQJUaJh3x>*CJOJQJaJ"jh3x>*CJOJQJUaJhrh3xCJOJQJaJh3xCJOJQJaJ DpD  B & HJ T0*gd3x$ Pa$gd3x Px@&gd3x Pxgd3x Edh7$8$@&H$gd3x Edh7$8$H$gd3xp 246@BDNZ^`tvx~ֿ֯֓{ֿ֯oo֓Wֿo֓.jDh|Th3x>*CJOJQJUaJh3xCJOJQJaJ.jh|Th3x>*CJOJQJUaJh3x>*CJOJQJaJhrh3xCJOJQJaJhrh3x>*CJOJQJaJ-jh3x>*CJOJQJUaJmHnHu"jh3x>*CJOJQJUaJ.j\h|Th3x>*CJOJQJUaJ "$&:<>DFHJְֿֿ֤֗֗gֿ֤֗Oֿ֤.jh|Th3x>*CJOJQJUaJ.jh|Th3x>*CJOJQJUaJ.j,h|Th3x>*CJOJQJUaJh3x>*CJOJQJaJh3xCJOJQJaJhrh3xCJOJQJaJ-jh3x>*CJOJQJUaJmHnHu"jh3x>*CJOJQJUaJ.jh|Th3x>*CJOJQJUaJJ^`blnp  0 2 4 > @ \ ^ ` t ȱȡnȱȒVȱȒFh|Th3x>*CJOJQJaJ.jphtQ|h3x>*CJOJQJUaJ.jhtQ|h3x>*CJOJQJUaJh3xCJOJQJaJhrh3xCJOJQJaJhrh3x>*CJOJQJaJ-jh3x>*CJOJQJUaJmHnHu"jh3x>*CJOJQJUaJ.jh|Th3x>*CJOJQJUaJh3x>*CJOJQJaJt v x     " $ & : ְְֿֿ֗p֗Xֿ֤֗.jh|Th3x>*CJOJQJUaJhm'h3xCJOJQJaJ.jDhtQ|h3x>*CJOJQJUaJh3x>*CJOJQJaJh3xCJOJQJaJhrh3xCJOJQJaJ-jh3x>*CJOJQJUaJmHnHu"jh3x>*CJOJQJUaJ.jhtQ|h3x>*CJOJQJUaJ: < > H J N P ְֿֈpֿ֤ֈXְֿF" jhm'h3xCJOJQJaJ.j h|Th3x>*CJOJQJUaJ.jh|Th3x>*CJOJQJUaJh3x>*CJOJQJaJhm'h3xCJOJQJaJh3xCJOJQJaJhrh3xCJOJQJaJ-jh3x>*CJOJQJUaJmHnHu"jh3x>*CJOJQJUaJ.j"h|Th3x>*CJOJQJUaJ   4 6 8 < A L % & 6 7 A B ůŠ}Šk^Fk.jf htQ|h3x>*CJOJQJUaJh3x>*CJOJQJaJ"jh3x>*CJOJQJUaJ+jh3xh3xCJOJQJUaJh3x5CJOJQJaJhrh3xCJOJQJaJ+j~h3xh3xCJOJQJUaJh3xCJOJQJaJjh3xCJOJQJUaJhrh3x5CJOJQJaJhm'h3xCJOJQJaJ   "68:DFHJǻǬ֏w֏gZgJjh3xCJOJQJUaJh3x5CJOJQJaJhrh3x5CJOJQJaJ.j htQ|h3x>*CJOJQJUaJh3x>*CJOJQJaJhtQ|h3x>*CJOJQJaJh+h3xCJOJQJaJh3xCJOJQJaJhrh3xCJOJQJaJ"jh3x>*CJOJQJUaJ-jh3x>*CJOJQJUaJmHnHuJ~"$ Pxx$Ifa$gd3xlC#kdN $$Ifl֞ *fF t064 l4al&(*,@BDNPRThjlvxz|ٴ٨ٴ٨|ٴ٨fٴ٨P+j hV\h3xCJOJQJUaJ+j| hV\h3xCJOJQJUaJ+j hV\h3xCJOJQJUaJ+j hV\h3xCJOJQJUaJh3xCJOJQJaJhrh3xCJOJQJaJ*jh3xCJOJQJUaJmHnHujh3xCJOJQJUaJ+j hV\h3xCJOJQJUaJ*Rz P$Ifgd3xlC  246@BDFZ\^hjlnԾԒ|f+jhV\h3xCJOJQJUaJ+jhV\h3xCJOJQJUaJ+j hV\h3xCJOJQJUaJ*jh3xCJOJQJUaJmHnHu+jh hV\h3xCJOJQJUaJh3xCJOJQJaJhrh3xCJOJQJaJjh3xCJOJQJUaJ #kdH$$Ifl1֞ *fF t064 l4alDl 4 P$Ifgd3xlC  "$&0ٴ٨ٴ٨|ٴ٨fٴ٨P+jhV\h3xCJOJQJUaJ+jbhV\h3xCJOJQJUaJ+jhV\h3xCJOJQJUaJ+jvhV\h3xCJOJQJUaJh3xCJOJQJaJhrh3xCJOJQJaJ*jh3xCJOJQJUaJmHnHujh3xCJOJQJUaJ+jhV\h3xCJOJQJUaJ0268:VXZ^!"34>?  DFZ\^hjnprvx|~µ禎}g}_hxuh3x5+j hV\h3xCJOJQJUaJ*jh3xCJOJQJUaJmHnHu+jhV\h3xCJOJQJUaJh3xCJOJQJaJh+h3xOJQJaJ hrh3xj h3xUjh3xUh3xhrh3xCJOJQJaJjh3xCJOJQJUaJ#468%$  0*a$gd3xkdB$$Ifl֞ *fF t064 l4al8"*+QRXYo T0*PP$Ifgd3xl$ T0*PP$Ifa$gd3xl $  0*a$gd3xopJ+$ T0*PP$Ifa$gd3xlkd~$$IfTl֞  )e  t4 l4aT T0*PP$Ifgd3xlJ+$ T0*PP$Ifa$gd3xlkd$$IfTl֞  )e  t4 l4aT T0*PP$Ifgd3xl2J>$ T0*xx$Ifa$gd3xl T0*xgd3xkd$$IfTl֞  )e  t4 l4aT23BDl$ T0*xx$Ifa$gd3xl$ T0*xx$Ifa$gd3xllnptvz|L=;;;; 0*dhgd3xkd$$Ifl֞ X f!*R  $ t*64 l4a|^`b 0*dhgd3x  gd3x$a$gd3x$&d@&Pa$gd3x $@&a$gd3x ^`bhrh3xCJOJQJaJhUh3xCJOJQJaJh3xCJOJQJaJh3x hNNih3xhm'h3x5CJOJQJaJ":p3x/ =!"#8$%tDText1tD Text2tDText3tDFText4tDPText5tDText6tDText7tDText6tDText7tDText6tDText7tDText8jDjD#jD#tDText6tDText7tDText6tDText7tDeCheck1tDeCheck2tDAText9tDAText9$$Ifl!vh5555 555 #v #v#v#v #v#v#v:Vl t6,5 5F555falvDText10vDText12vDText12vDText12vDText11vDText11jD$$Ifl!vh5555 555 #v #v#v#v #v#v#v:Vl1 t6,5 5F555falvDText10vDText12vDText12vDText12vDText11vDText11jD$$Ifl!vh5555 555 #v #v#v#v #v#v#v:Vl t6,5 5F555faltDeCheck3$$If!vh5e 555555#v#v#v#v#v#v#ve :Vl t0,5555555e T$$If!vh5e 555555#v#v#v#v#v#v#ve :Vl t0,5555555e T$$If!vh5e 555555#v#v#v#v#v#v#ve :Vl t0,5555555e TvD Text13vD Text14$$If!vh5R 5555 55$ #v$ #v#v #v#v#v#vR :Vl t0*65$ 55 5555R 8@8 Normal_HmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List `$@` Envelope Address!@ &+D/^@ CJ8>@8 Title $a$5CJ6B@6 Body TextCJlP@"l Body Text 27$d%d&d'd(d @ X %2CJ4@24 Header  !4 @B4 Footer  !n@Sn NNi Table Grid7:V0_HVYbV Bi Document Map-DM CJOJQJaJX X zX X8nB&Kgh(<PQeyemn   : ; A B X Y Z u v 2 3 4 U Y 0@P0@P0@P0@P0@P0@P0@P0@P0@P0@P0@P0@P0@P0@P0@P0@P0@P 0@P 0@P 0@P 0@P 0@P 0@P 0DP 0@P 0@P 0@P 0@P 0@P 0@P 0@P 0DP 0@P 0@P 0@P 0@P 0@P 0@P 0@P 0DP 0@P0@P0@P 0@P 0@P 0@P 0@P 0@P 0@P 0DP 0@P 0@P 0@P 0@P 0@P 0@P 0@P 0DP 0@P 0@P 0@P 0@P 0@P 0@P 0@P 0DP 0@P0@P 0@P 0@P 0@P 0@P 0@P 0@P 0DP 0@P`BB0@#v 0@ 0@ 0@ xx0@ A? yyJt : 0 +J48o2l|!"#$%&'()*#(4:FRVq}"$06bnt $FRVXdj6BHS_e  &(4:<HNQ]ceqwyv X FFFFFFFFFFFFFFFFFFFG G FFFFFFFFFFFFFFFFG FF@  @H 0(  0(  B S  ?Text1Text2Text3Text4Text5Text6Text7Text8Check1Check2Text9Text10Text12Text11Check3Text13Text14(Fqb6(v Y  $;WuI; Y Y Yb Y :&h(<PQeydemn   : ; A B X Y Z u v V Y 5A@#0bXCCC X PP P@PPP$@PUnknownGTimes New Roman5Symbol3 ArialA Arial Narrow;WingdingsCLucida Grande"hXfXfFhsHă!24d :3qHP?n=SERVICE(S) PLAN FOR PARENTALLY PLACED PRIVATE SCHOOL STUDENTSSDCOE Kelly Brooks Oh+'0  8D d p | '@SERVICE(S) PLAN FOR PARENTALLY PLACED PRIVATE SCHOOL STUDENTSSDCOESELPA 29.dotKelly Brooks2Microsoft Word 11.5.5@F#@&2@qh@qhh ՜.+,0( hp  'SDCOE  >SERVICE(S) PLAN FOR PARENTALLY PLACED PRIVATE SCHOOL STUDENTS Title  !"#$%&'()*+,./0123456789;<=>?@ABCDEFGHJKLMNOPRSTUVWX[Root Entry F=VRh]Data -1Table:WordDocument$XSummaryInformation(IDocumentSummaryInformation8QCompObjXObjectPool=VRh=VRh FMicrosoft Word DocumentNB6WWord.Document.8