A notice form is used many instances. There are many types of notices including legal court notices, eviction notices, school notices, business notices and other personal notices. Generally, notices are used to bring to the addressee attention to a certain matter that will require the participation of the subject. This is a sample notice form.
Sample Notice Form
To: _____________________________________________________________________
Address: ____________________ City _____________ State: ___________ Zip: _______
Phone: ________________ Email: _________________ Fax: ________________________
Relationship with student in record _____________________________________________
Re: Student’s Name: _______________________________________________________
This notice is to bring to your attention that we are
1. Proposing _____________ Refusing to __________ other _________________
A / an
2. Initiate _______________ Changing ____________ other _________________
(Mark one of the above)
3. Referral ______________ Evaluation ____________ Eligibility _______________
(Mark one)
Category Educational placement _________ IEP _______ reevaluation ____________
Disciplinary action _____________ Change of placement __________ 504 Plan _________
Description of proposed action ________________________________________________
_________________________________________________________________________
Reasons for taking this action _________________________________________________
_________________________________________________________________________
Other actions that were considered but rejected ___________________________________
_________________________________________________________________________
Reasons for rejection ________________________________________________________
_________________________________________________________________________
Name: _____________________________________ Title ________________________
Signature _________________________ Date ____________________
