Surrogate Parent Participation Log

Student First Name, Last Initial Only: _____________________________________________________ Student ID #: _________________________

School: _____________________________________________ Name of Surrogate Parent: ______________________________________________

Roles and Responsibilities of Surrogate Parent
A surrogate parent has the responsibility to ensure that the school provides the student with a free appropriate public education (FAPE). To accomplish this responsibility, the surrogate has agreed to exercise independent judgment in pursuing the student's interest and exercise the student's due process rights.

Write the date in the first column. Check the appropriate purpose(s). Comment if appropriate.

Date of Visit
	Purpose of Visit
	
	Visit the student and the student's school
	
Participate in parent teacher conferences
	
Review the student's educational records

Attend ETR/IEP meetings

Comments

						

Form D- Optional	2/11/2018

Date of Visit
	Purpose of Visit
	
	Visit the student and the student's school
	
Participate in parent teacher conferences
	
Review the student's educational records

Attend ETR/IEP meetings

Comments

						

						

						

						

Form D- Optional	2/11/2018