Joint Advocacy Initiative | PDOP & VFAB

Joint Action: Special Education Evaluation Delays

Both forms must be completed.

There are two separate authorizations below. Please fill out and sign both of them. Form 1 lets us work with the school district directly to try to fix this locally. Form 2 lets us include your child's evaluation timeline in the state complaint to the Nevada Department of Education if the district does not resolve it.

Joint Action: Special Education Evaluation Delays

Authorization for Joint Advocacy and two-way data sharing with the Nye County School District

I am aware that The Pahrump Disability Outreach Program (PDOP) and Voices for All Abilities (VFAB) are working on a formal Joint Systemic State Administrative Complaint to the Nevada Department of Education (NDE) regarding unlawful evaluation waitlists and omitted Prior Written Notices across Nye County School District.

I am aware that PDOP and VFAB would rather resolve this locally if possible prior to going outside the district and am willing to attempt this regarding my child.

Questions or need assistance? Call 702-516-0847 before or while completing this form.

Student details

Student legal full name

Date of birth

Student ID # (optional)

School / campus

Grade level

Parent / guardian details

Full legal name(s)

Relationship to student

Phone number

Format: (702) 555-0134

Email address

Mailing address

City

Zip code

Required authorizations

In an effort to facilitate their efforts to do so, I agree to the following:

Designation of Joint AdvocatesI/we authorize PDOP and VFAB to advocate for our student's educational interests jointly regarding evaluations, Child Find compliance, and related administrative proceedings.Cross-Organizational Record Disclosure (FERPA / IDEA)Pursuant to 34 C.F.R. § 99.30, 34 C.F.R. § 300.622, and NAC § 388.289, I/we authorize PDOP and VFAB to share, review, and exchange my child's educational records and evaluation documentation with each other to coordinate joint advocacy. I/we authorize the school district to disclose evaluation records and discuss timelines and documents surrounding this issue with both organizations without me present.Term & RevocationThis authorization remains in effect for one (1) calendar year or through the conclusion of the school district's investigation. I may revoke this in writing at any time.

Digital signature

Draw your signature with a finger, stylus or mouse. Optional: your typed full legal name below is your signature of record.

Typed full legal name

Signature date

Typing your full legal name acts as your electronic signature. Your consent is delivered securely to PDOP and VFAB, and a PDF copy downloads to your device.

This authorization is provided solely to Pahrump Disability Outreach Program (PDOP) and Voices for All Abilities (VFAB) for the purposes described above.