Florida Department of Education
Parental Consent Form
Instruction in the State Standards Access Points Curriculum and
Statewide, Standardize d Alternate Assessment
Form 313181
Rule 6A-6.0331
Effective December 2014
Student: Date:
Student D.O.B.: Parent(s) Name:
District: School:
I understand that, as a participant of the individual educational plan (IEP) team, I have the right to consent or refuse consent for my
child (or myself, if I am an adult student) to be provided instruction in the state standards access points curriculum and to be
administered the statewide, standardized alternate assessment (if applicable, based on my child’s grade level).
Based on Section 1003.5715, Florida Statutes, I understand that the ___________________ County School District may not provide
instruction in the state standards access points curriculum and administer the statewide, standardized alternate assessment unless I
have provided written consent on this form; or the school district made documented and reasonable efforts to obtain my consent, and I
have failed to respond; or the school district obtains approval through a due process hearing and/or appeals process. I understand that,
during the pendency of a due process hearing or appellate proceeding regarding a due process complaint, my child will remain in his
or her current educational assignment while awaiting the decision of the due process hearing or court proceeding, unless the school
district and I otherwise agree.
My consent is being sought because the IEP team has determined that the proposed actions are necessary in order for my child to
receive a free appropriate public education. If I refuse to consent to the proposed actions, my child may not receive all the services and
supports that the IEP team has determined are needed, which may impact my child’s educational progress. I understand that, if I give
consent, my child may receive instruction within the general education setting based on his or her IEP but the instruction received may
not prepare my child for some postsecondary opportunities such as enrollment in a degree-seeking college program or enlistment in
the military. I understand that, if my child entered grade 9 prior to the 2014-2015 school year, instruction in access points and
participation in the statewide, standardized alternate assessment may result in the attainment of a special diploma which may impact
access to future opportunities such as enrollment in a degree-seeking college program or enlistment in the military. This consent will
remain in effect until the next annual review of the IEP, or until the next IEP meeting if instruction in state standards access points
curriculum and administration of the statewide, standardized alternate assessment are addressed, whichever event occurs first.
I consent for the provision of instruction in the state standards access points curriculum and administration of the statewide,
standardized alternate assessment (if applicable, based on my child’s grade level).
______________________________ __________ ___________________________ _________
Parent signature Date Parent signature Date
I do not consent for the provision of instruction in the state standards access points curriculum and administration of the statewide,
standardized alternate assessment (if applicable, based on my child’s grade level).
______________________________ ________ ___________________________ _________
Parent signature Date Parent signature Date
If you sign “I do not consent,” within ten school days, the school district must develop and implement new instruction and assessment
procedures in accordance with a new IEP or must request a due process hearing.
You have specific rights and protections that are described in the Notice of Procedural Safeguards for Parents of Students with
Disabilities. To receive a copy, or for assistance understanding your rights, contact:
___________________________ at _________________ OR _________________ at __________________
(District designee) (Telephone/email) (Alternate contact) (Telephone/email)
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