Revocation of Consent - Particular 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 particular 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-Particular 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 Particular 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)
