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 ____________________

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