Preview
Electronically Filed
7/7/2021 11:01 AM
Penny Clarkston, Smith County District Clerk
Reviewed By: Daisy Duran
CAUSE NO. 21-0772-D
IN THE INTEREST OF § IN THE DISTRICT COURT
§
§
§ SMITH COUNTY, TEXAS
H.W. §
§
§
§
§
CHILD § 32137 DISTRICT COURT
EDUCATIONAL DECISION MAKER
Hayden Wilcox
of Form K-910-2085-E
TexasoDepartment . o
Faxmly and Protectlve Seances Revised Febmary 2020
DESIGNATION 0F EDUCATION DECISION-MAKER
Purpose: DFPS must ensure that this form is provided to the court and the child's school under Texas Family Code
§2§3.QQ4 within five days of the Adversary Hearing. DFPS must inform the court of any changes in the Education
Decision-Maker or Surrogate Parent, if applicable, in the next permanency hearing report. DFPS must provide the
updated information to the school no later than five days after any changes in the Education Decision-Maker or
Surrogate Parent, ifapplicable.
This form’s references to any "DFPS" worker refers to employees of the Department of Family and Protective Services
or employees of a Single Source Continuum Contractor (SSCC). The SSCC acts as an authorized agent of DFPS
pursuant to Texas Family Code Chapter 264 Subchapter B-1. The SSCC has the same authority as DFPS regarding
case management duties and associated responsibilities.
Dlrectlons: To complete this form, fillinall applicable fields. For additional questions, contact your Regional
Education Specialist. DFPS staff may not appoint a surrogate parent. DFPS staff may only list the name of the
surrogate parent appointed by the court or the school.
The Single Source Continuum Contract (SSCC) is
SECTION 1: AUTHORITY TO MAKE EDUCATION DECISION
The Texas Department of Family and Protective Services (DFPS) is authorized by court order as provided in the
Texas Family Code 5153.371 to make education decisions on behalf of the following child currently in the
conservatorship of DFPS.
Child's Full Name: Child's DFPS IMPACT Person ID: Child's Medicaid Number:
Hayden Wilcox 103979658 709327986
Date of Birth: County: Court Number: Cause Number:
12/31/201 5 Smith 321st 21-0772-D
DFPS delegates to the following individual(s) (hereinafter referred to as the Education Decision-Maker) the
education decision-making responsibilities on behalf of the child as described in this form. Note: A representative
of DFPS may be named as a primary and and/or backup EducatIOn Decision-Maker.
Designated primary Education Decision-Maker (and spouse, if applicable): Date of designation:
Carol and Bobby Dyess 06/1 112021
Email: Telephone Number(s):
Backup Education Decision-Maker: Date of designatiOn:
Kim McCurley 06/1 1/2021
Surrogate EducatiOn Decision-Maker for special Date of designation: Designated by;
education decisions:
D Court
D Iso
Email: Telephone Number(s):
Page 1 of 5
of Form K-91o-2085-E
TexaDePartment . _
Famlly and Protectlve Sennces Revised February 2020
SECTION 2: SPECIAL EDUCATION RIGHTS AND RESPONSIBILTIES IF APPLICABLE
Federal and state law authorize the individual who is acting in the role of the child's parent or who is appointed by
the school or the court to be the "surrogate parent" forthe child to exercise the rights and responsibilities as
outlined by the Individuals with Disabilities Education Act and state law and rule. The individual is usually the foster
parent or daily caregiver, but may be a Court Appointed Special Advocate or other individual with knowledge of the
child. In some cases the biological parent may retain the right to make certain special education decisions.
The law does not allow a DFPS staff perSOn, school district staff, or anyone employed to provide care or treatment
for the child to act as the parent or surrogate for special education decision-making. A foster parent is not
considered a person employed to provide care for the child.
At age 18, the rights of the parent to make education decisions are transferred to the child, except for the child
with a disability who has been determined to be incapacitated under state law.
Page 2 of 5
0f
TexaDePament ‘ Form K-91 0-2085-E
Pamlly and Protechve Semces
O
Revised February 2020
SECTION 3: EDUCATION DECISION-MAKER AND RESPONSIBILITIES
Unless otherwise indicated by pr0visions in this form, the Education Decision-Maker has the right and responsibility
to:
o Enroll a child in the school chosen by DFPS, including providing identity or immunization information needed for
enrollment.
o Determine, in conjunction with the child, if appropriate, course selection and participation inacademic electives
and activities.
o Determine whether the child should participate in special programs such as compensatory programs, bilingual
education, Gifted and Talented, after-school tutoring, etc.
o Attend routine activities such as "Parent's Night," parent-teacher conferences, PTA meetings, and similar
activities that involve parents.
o
Approve child's participation inroutine or non-routine school activities such as track and eld, museum or eld
trips, etc.
o Be notified of injury or illness at a school activity on or off school grounds.
o
Sign the Student Code of Conduct, and, if applicable, assist youth with understanding the Code of Conduct.
o
Sign the annual directive to the school prohibiting the use of corporal punishment for the child and provide a
copy to the caseworker for the child's case file.
o Receive report cards, permission slips,and other routine school correspondence including receiving homework
assignments on behalf of the child if necessary.
o Have access to education records and the Education Portfolio.
o Be notified of and take action regarding disciplinary or attendance matters.
o Determine when a referral for a special education evaluation is necessary or make a referral for an evaluation.
The Education Decision-Maker has the following additional responsibilities:
o Meet with the child before making education decisions to ensure that the child's educational goals are
appropriate and in the least restrictive environment.
o Review the child's Education Portfolio and pertinent educational records.
o Provide regular updates about the child's education to the DFPS caseworker, including copies of significant
forms, records, and communication from the school.
o Inform the DFPS caseworker of any notication from the school regarding the child's disciplinary hearings,
manifestation determination reviews, use of physical restraints and/or seclusion, truancy, suspension, expulsion, or
removal to a Disciplinary Alternative Education Program (DAEP) or Juvenile Justice Alternative Education Program
(JJAEP). Inform the caseworker of notices for all education-related activities which involve Section 504 of the
Rehabilitation Act or notices of special education Admission, Review, and Dismissal (ARD) committee meetings
received.
o Ensure a copy of this Form 2085E has been provided to the child's school within ve days of being named
Education Decision-Maker.
Notes:
The Education Decision-Maker may be instructed by the caseworker to notify or consult with the caseworker or
supervisor on any of these matters before communicating a decision to the school.
Unless otherwise indicated in Section 1 or Section 4, the daily caregiver with whom the child lives (foster parent,
relative caregiver, or facility staff) may be involved in and notied regarding activities and decisions listed above
which have a clear impact on the child's home life.For example, the caregiver is generally responsible for decisions
about participation in extracurricular activities, sporting activities and events, dances, clubs, etc., regardless of
whether the caregiver is also the child's designated Education Decision-Maker.
Page 3 of 5
0f Form K-91 0-2085-5
TexaSODePament .
Famy and Protechve Services Revised February 2020
SECTION 4: BIOLOGICAL FAMILY RIGHTS AND RESPONSIBILITIES, IF APPICABLE
A biological parent of a child in DFPS Managing Conservatorship retains only the educational decision-making rights
expressly ordered by the court. For the child named in this form, the following rights have been retained by or
granted to the biological parents:
SECTION 5: CASEWORKER RIGHTS AND RESPONSIBILITIES
The DFPS caseworker has the right to:
o Access education records regarding the child.
o Select the appropriate school for the child.
- Receive notication regarding disciplinary hearings, manifestation determination reviews, use of physical
restraints and/or seclusion, truancy, suspension, expulsion, Class C misdemeanor tickets, or removal to a
Disciplinary Alternative Education Program (DAEP) or Juvenile Justice Alternative Education Program (JJAEP).
o Receive notications for alleducation-related activities which involve Section 504 of the Rehabilitation Act or
special education Admission, Review, and Dismissal committee meetings.
The caseworker is responsible for:
o
Informing the child's attorney ad litem, guardian ad litem, CASA volunteer, caregiver, and education decision-
maker of any notication from the school regarding the child’s disciplinary hearings, manifestation determination
reviews, use of physical restraints and/or seclusion, truancy, suspension, expulsion, or removal to a Disciplinary
Alternative Education Program (DAEP) or Juvenile Justice Alternative Education Program (JJAEP).
o Informing the education decision-maker designee, the caregiver, or the surrogate parent, as applicable, of any
education-related activities which involve Section 504 of the Rehabilitation Act and or special education Admission,
Review, and Dismissal committee meetings, if known.
o
Informing the school of any changes in naming the Education Decision-Maker or Surrogate Parent, if applicable,
within ve days of the change.
o
Ensuring that the annual directive to the school prohibiting the use of corporal punishment for the child is on
file with the school and placed in the child's case le.
o Updating the Education Portfolio.
The DFPS caseworker must ensure that this form Is provided to the court and the child's school under
Texas Family Code, Section 263.004 wlthln ve days of the Adversary Hearing. The caseworker must
Inform the court of changes In naming the Education Decision-Maker (or Surrogate Parent, If
applicable) in the next permanent pmress report.
Page 4 of 5
0f Form K-91o-2085-E
TexaDePamem o
and Protective Semces
o
Famy Revised February 2020
SECTION 6: SCHOOL RESPONSIBILITES
o
Keep this 2085 E form condential with the student’s other privacy-protected education records.
o Ensure records are transferred within ten days if a student changes schools.
o
Notify the DFPS caseworker and/or the Education Decision-Maker of signicant school events as required
PRIVACY STATEM ENT
DFPS values your privacy. For more information, read our Privacy and Security Policy.
As the Education Decision-Maker, I acknowledge and agree that:
o I have no professional interests that conflict with the interest of the child I represent.
o I will comply with the Education Decision-Maker Rights and Responsibilities as described in SECTION 3.
o I understand that failure to cooperate wlth DFPS may be the basis for revoking this designation.
EducationuDecision-Maker signature: Date Signed:
X 06/1 1/2021
413/
Backup signature: Date Signed:
06/1 112021
r'
Preview
Electronically Filed 7/7/2021 11:01 AM Penny Clarkston, Smith County District Clerk Reviewed By: Daisy Duran CAUSE NO. 21-0772-D IN THE INTEREST OF § IN THE DISTRICT COURT § § § SMITH COUNTY, TEXAS H.W. § § § § § CHILD § 32137 DISTRICT COURT EDUCATIONAL DECISION MAKER Hayden Wilcox of Form K-910-2085-E TexasoDepartment . o Faxmly and Protectlve Seances Revised Febmary 2020 DESIGNATION 0F EDUCATION DECISION-MAKER Purpose: DFPS must ensure that this form is provided to the court and the child's school under Texas Family Code §2§3.QQ4 within five days of the Adversary Hearing. DFPS must inform the court of any changes in the Education Decision-Maker or Surrogate Parent, if applicable, in the next permanency hearing report. DFPS must provide the updated information to the school no later than five days after any changes in the Education Decision-Maker or Surrogate Parent, ifapplicable. This form’s references to any "DFPS" worker refers to employees of the Department of Family and Protective Services or employees of a Single Source Continuum Contractor (SSCC). The SSCC acts as an authorized agent of DFPS pursuant to Texas Family Code Chapter 264 Subchapter B-1. The SSCC has the same authority as DFPS regarding case management duties and associated responsibilities. Dlrectlons: To complete this form, fillinall applicable fields. For additional questions, contact your Regional Education Specialist. DFPS staff may not appoint a surrogate parent. DFPS staff may only list the name of the surrogate parent appointed by the court or the school. The Single Source Continuum Contract (SSCC) is SECTION 1: AUTHORITY TO MAKE EDUCATION DECISION The Texas Department of Family and Protective Services (DFPS) is authorized by court order as provided in the Texas Family Code 5153.371 to make education decisions on behalf of the following child currently in the conservatorship of DFPS. Child's Full Name: Child's DFPS IMPACT Person ID: Child's Medicaid Number: Hayden Wilcox 103979658 709327986 Date of Birth: County: Court Number: Cause Number: 12/31/201 5 Smith 321st 21-0772-D DFPS delegates to the following individual(s) (hereinafter referred to as the Education Decision-Maker) the education decision-making responsibilities on behalf of the child as described in this form. Note: A representative of DFPS may be named as a primary and and/or backup EducatIOn Decision-Maker. Designated primary Education Decision-Maker (and spouse, if applicable): Date of designation: Carol and Bobby Dyess 06/1 112021 Email: Telephone Number(s): Backup Education Decision-Maker: Date of designatiOn: Kim McCurley 06/1 1/2021 Surrogate EducatiOn Decision-Maker for special Date of designation: Designated by; education decisions: D Court D Iso Email: Telephone Number(s): Page 1 of 5 of Form K-91o-2085-E TexaDePartment . _ Famlly and Protectlve Sennces Revised February 2020 SECTION 2: SPECIAL EDUCATION RIGHTS AND RESPONSIBILTIES IF APPLICABLE Federal and state law authorize the individual who is acting in the role of the child's parent or who is appointed by the school or the court to be the "surrogate parent" forthe child to exercise the rights and responsibilities as outlined by the Individuals with Disabilities Education Act and state law and rule. The individual is usually the foster parent or daily caregiver, but may be a Court Appointed Special Advocate or other individual with knowledge of the child. In some cases the biological parent may retain the right to make certain special education decisions. The law does not allow a DFPS staff perSOn, school district staff, or anyone employed to provide care or treatment for the child to act as the parent or surrogate for special education decision-making. A foster parent is not considered a person employed to provide care for the child. At age 18, the rights of the parent to make education decisions are transferred to the child, except for the child with a disability who has been determined to be incapacitated under state law. Page 2 of 5 0f TexaDePament ‘ Form K-91 0-2085-E Pamlly and Protechve Semces O Revised February 2020 SECTION 3: EDUCATION DECISION-MAKER AND RESPONSIBILITIES Unless otherwise indicated by pr0visions in this form, the Education Decision-Maker has the right and responsibility to: o Enroll a child in the school chosen by DFPS, including providing identity or immunization information needed for enrollment. o Determine, in conjunction with the child, if appropriate, course selection and participation inacademic electives and activities. o Determine whether the child should participate in special programs such as compensatory programs, bilingual education, Gifted and Talented, after-school tutoring, etc. o Attend routine activities such as "Parent's Night," parent-teacher conferences, PTA meetings, and similar activities that involve parents. o Approve child's participation inroutine or non-routine school activities such as track and eld, museum or eld trips, etc. o Be notified of injury or illness at a school activity on or off school grounds. o Sign the Student Code of Conduct, and, if applicable, assist youth with understanding the Code of Conduct. o Sign the annual directive to the school prohibiting the use of corporal punishment for the child and provide a copy to the caseworker for the child's case file. o Receive report cards, permission slips,and other routine school correspondence including receiving homework assignments on behalf of the child if necessary. o Have access to education records and the Education Portfolio. o Be notified of and take action regarding disciplinary or attendance matters. o Determine when a referral for a special education evaluation is necessary or make a referral for an evaluation. The Education Decision-Maker has the following additional responsibilities: o Meet with the child before making education decisions to ensure that the child's educational goals are appropriate and in the least restrictive environment. o Review the child's Education Portfolio and pertinent educational records. o Provide regular updates about the child's education to the DFPS caseworker, including copies of significant forms, records, and communication from the school. o Inform the DFPS caseworker of any notication from the school regarding the child's disciplinary hearings, manifestation determination reviews, use of physical restraints and/or seclusion, truancy, suspension, expulsion, or removal to a Disciplinary Alternative Education Program (DAEP) or Juvenile Justice Alternative Education Program (JJAEP). Inform the caseworker of notices for all education-related activities which involve Section 504 of the Rehabilitation Act or notices of special education Admission, Review, and Dismissal (ARD) committee meetings received. o Ensure a copy of this Form 2085E has been provided to the child's school within ve days of being named Education Decision-Maker. Notes: The Education Decision-Maker may be instructed by the caseworker to notify or consult with the caseworker or supervisor on any of these matters before communicating a decision to the school. Unless otherwise indicated in Section 1 or Section 4, the daily caregiver with whom the child lives (foster parent, relative caregiver, or facility staff) may be involved in and notied regarding activities and decisions listed above which have a clear impact on the child's home life.For example, the caregiver is generally responsible for decisions about participation in extracurricular activities, sporting activities and events, dances, clubs, etc., regardless of whether the caregiver is also the child's designated Education Decision-Maker. Page 3 of 5 0f Form K-91 0-2085-5 TexaSODePament . Famy and Protechve Services Revised February 2020 SECTION 4: BIOLOGICAL FAMILY RIGHTS AND RESPONSIBILITIES, IF APPICABLE A biological parent of a child in DFPS Managing Conservatorship retains only the educational decision-making rights expressly ordered by the court. For the child named in this form, the following rights have been retained by or granted to the biological parents: SECTION 5: CASEWORKER RIGHTS AND RESPONSIBILITIES The DFPS caseworker has the right to: o Access education records regarding the child. o Select the appropriate school for the child. - Receive notication regarding disciplinary hearings, manifestation determination reviews, use of physical restraints and/or seclusion, truancy, suspension, expulsion, Class C misdemeanor tickets, or removal to a Disciplinary Alternative Education Program (DAEP) or Juvenile Justice Alternative Education Program (JJAEP). o Receive notications for alleducation-related activities which involve Section 504 of the Rehabilitation Act or special education Admission, Review, and Dismissal committee meetings. The caseworker is responsible for: o Informing the child's attorney ad litem, guardian ad litem, CASA volunteer, caregiver, and education decision- maker of any notication from the school regarding the child’s disciplinary hearings, manifestation determination reviews, use of physical restraints and/or seclusion, truancy, suspension, expulsion, or removal to a Disciplinary Alternative Education Program (DAEP) or Juvenile Justice Alternative Education Program (JJAEP). o Informing the education decision-maker designee, the caregiver, or the surrogate parent, as applicable, of any education-related activities which involve Section 504 of the Rehabilitation Act and or special education Admission, Review, and Dismissal committee meetings, if known. o Informing the school of any changes in naming the Education Decision-Maker or Surrogate Parent, if applicable, within ve days of the change. o Ensuring that the annual directive to the school prohibiting the use of corporal punishment for the child is on file with the school and placed in the child's case le. o Updating the Education Portfolio. The DFPS caseworker must ensure that this form Is provided to the court and the child's school under Texas Family Code, Section 263.004 wlthln ve days of the Adversary Hearing. The caseworker must Inform the court of changes In naming the Education Decision-Maker (or Surrogate Parent, If applicable) in the next permanent pmress report. Page 4 of 5 0f Form K-91o-2085-E TexaDePamem o and Protective Semces o Famy Revised February 2020 SECTION 6: SCHOOL RESPONSIBILITES o Keep this 2085 E form condential with the student’s other privacy-protected education records. o Ensure records are transferred within ten days if a student changes schools. o Notify the DFPS caseworker and/or the Education Decision-Maker of signicant school events as required PRIVACY STATEM ENT DFPS values your privacy. For more information, read our Privacy and Security Policy. As the Education Decision-Maker, I acknowledge and agree that: o I have no professional interests that conflict with the interest of the child I represent. o I will comply with the Education Decision-Maker Rights and Responsibilities as described in SECTION 3. o I understand that failure to cooperate wlth DFPS may be the basis for revoking this designation. EducationuDecision-Maker signature: Date Signed: X 06/1 1/2021 413/ Backup signature: Date Signed: 06/1 112021 r'