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William H. Bowen
School of Law

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Legal Clinics
- Clinical Programs
- Public Service and Pro Bono Opportunities
Externships
Client Information

Request for Mediation/IEP Facilitation

IEP facilitation is available to those participating in the 2013 Arkansas Department of Education Pilot Project.

Requesting party?
- Parent, adult, or guardian
- School district
Student's name
FirstLast
Date of birth
Parents' or guardians' names
Address
Street AddressAddress Line 2CityStateZip Code
Home phone
Work phone
Cell phone
Email
Parents' or guardians' names
Address
Street AddressAddress Line 2CityStateZip Code
Home phone
Work phone
Cell phone
Email
School name
School address
Street AddressAddress Line 2CityStateZip Code
School contact phone number
Do you have any special scheduling needs?
- Yes
- No
Suggested meeting dates or times
If no suggestions, are there times that would be particularly challenging for you to meet?
Student and parent or guardian information
Is there an advocate?
- Yes
- No
If so, please list name and contact information:
Is there legal representation?
- Yes
- No
If so, please list name and contact information:
Summary of issues to be discussed:
Are there any other circumstances about the student that we should be aware of?
School and district information
School representative name
Position or title
Address
Street AddressAddress Line 2CityStateZip Code
Work phone
Cell phone
Email
If this meeting is involving a facilitated IEP, rather than a mediation, please answer the following questions
Date and time of proposed facilitation
Type of IEP
- First
- Annual
- Three-year re-evaluation
- Other
Date of last IEP meeting
IEP renewal date
Has the team met previously for the current IEP?
- Yes
- No
If you have met before how long was the meeting?
Who is responsible for overseeing drafting the IEP?
Is someone else responsible for overseeing implementation of the IEP?
- Yes
- No
If so, who?
What, if any, related services are involved?
Is the student involved with any programs outside of school?
- Yes
- No
If so, which are part of the IEP?
Where is the IEP team in the evaluation cycle?
Are there evaluation results that need to be shared prior to the meeting?
- Yes
- No
Who are the key people who will attend the IEP meeting and what required role, if any, will they fill?
What concerns are you expecting to present during the meeting?
Are there any other circumstances about the student that we should be aware of?
How did you hear about the program?

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Contact
- William H. Bowen
  School of Law
- 1201 McMath Avenue
  
  Little Rock, AR 72202
- Email: law@ualr.edu
- More contact information

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