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Series 602.5.1.3P - Permission for Retention Assessment

Adopted: October 2006



Dear Parent/Guardian,

We have reviewed the request for retention for your child, ____________________________.

That review has resulted in a recommendation to conduct a retention assessment. We
need your written permission with the testing. The following areas will be evaluated:

  • Social and emotional development;
  • Intellectual ability, and
  • Academic achievement.

Please indicate your permission to proceed with the assessment by signing and returning
the bottom portion of this sheet to me at your child’s school. If you have any questions,
please call ____________________________ at (        )                         .

                case manager                                    phone number


Signature of Principal



(cut and return bottom portion)


Request for Retention Assessment


        ❏ Yes, I give permission for the school to proceed with retention assessment of my child.

        ❏ No, I do not give the school permission to proceed with retention assessment of my child.


______________________________________________         ____________

Student’s Name                                                           Grade


______________________________________________         ____________

Signature of Parent or Guardian                                     Date

Received by principal ______________________________________________   ____________

                               Signature of Principal                                               Date