Revocation of Consent - All Services Sample Forms

Revocation of Consent forms may be useful to parents and LEAs when a parent wishes to exercise the right to revoke consent for special education services and placements.

KSDE has provided some of the languages spoken in Kansas. Any languages not listed here are not currently available from KSDE. These are model forms only; LEAs are not required to use these exact forms.

Revocation of Consent-All Services

English (PDF)
Amharic (PDF)
Arabic (PDF)
Burmese (PDF)
Chinese (PDF)
Chinese Traditional (PDF)
Hmong (PDF)
Lao (PDF)
Nepali (PDF)
Pashto (PDF)
Pohnpeian (PDF)
Polish (PDF)
Portuguese-Brazilian (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Swahili (PDF)
Ukrainian (PDF)
Vietnamese (PDF)

Prior Written Notice-Revocation of All Service

English (PDF)
Amharic (PDF)
Arabic (PDF)
Burmese (PDF)
Chinese (PDF)
Chinese Traditional (PDF)
Hmong (PDF)
Lao (PDF)
Nepali (PDF)
Pashto (PDF)
Pohnpeian (PDF)
Polish (PDF)
Portuguese-Brazilian (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Swahili (PDF)
Ukrainian (PDF)
Vietnamese (PDF)

For more information, please contact:

Mark Ward
Attorney
(785) 296-0920

Kansas leads the world in the success of each student.

900 S.W. Jackson Street, Suite 102
Topeka, Kansas 66612-1212
(785) 296-3201

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The Kansas State Department of Education does not discriminate on the basis of race, color, religion, national origin, sex, disability, or age in its programs and activities. For more information, visit our grievance procedure page.

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