Mpls Parent Refusal Form
Mpls Parent Refusal Form
Mpls Parent Refusal Form
This form is to be used for documenting parent refusals during the statewide
testing window. A copy of this form should be retained at the school for 12
months, and a copy should be sent to REA immediately upon completion.
To be completed by School:
School Name
_____________________________________
Name of Student
_____________________________________
Student ID#
_____________________________________
Student Grade
_____________________________________
Date of Request
_____________________________________
To be completed by Parent:
I am refusing the following testing for my student during the 2013-14 school year.
Test & Subject Refused _____ ________________________________
Name of Parent
____________________________________
Parent Signature
____________________________________
Date of Signature
____________________________________
Additional Comments
____________________________________
____________________________________