Delegation of Rights

In accordance with Illinois statute 105 ILCS 5/14-6.10

Enacted on August 23, 2007

I, __(insert name)____________, am 18 years of age or older and a student who has the right to make educational decisions for myself under State and federal law. I have not been adjudged incompetent and, as of the date of the execution of this document, I hereby delegate my right to give consent and make decisions concerning my education to ____(insert name)_____________, who will be considered my “parent” for purposes of the Individuals with Disabilities Education Improvement Act of 2004 and Article 14 of the School Code and will exercise all of the rights and responsibilities concerning my education that are conferred on a parent under those laws. I understand and give my consent for _______(insert name)_______, to make all decisions relating to my education on my behalf. I understand that I have the right to be present at meetings held to develop my individualized education program and that I have the right to raise any issues or concerns I may have and that the school district must consider them.

This delegation will be in effect for one year from the date of execution below and may be renewed by my written or other formal authorization. I also understand that I have the right to terminate this Delegation of Rights at any time and assume the right to make my own decisions regarding my education. I understand that I must notify the school district immediately if I revoke this Delegation of Rights prior to its expiration.

___________________________________            ________________________
Signature (of Student)                                         Date

___________________________________
Printed Name

Accepted by:

___________________________________            ________________________
Signature (of Designated Representative)             Date

___________________________________
Printed Name