IEP Timeline Waiver Request Form
Request a waiver or extension for an Individualized Education Program (IEP) timeline. Please complete all fields accurately.
Student Full Name
*
First Name
Last Name
Student Grade
*
Please Select
Pre-K
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Other
School Name
*
School District
*
Current IEP Timeline Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current IEP Timeline End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested New IEP Timeline End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Waiver/Extension Request
*
Your Name and Role/Relationship to Student
*
Submit Waiver Request
Should be Empty: