Portland Public Schools

  Portland, Oregon

501 N. DixonPortland, OR 97227(503) 916-2000

Surrogate Parent Forms

The procedure for processing surrogate parent applications is outlined in the Special Education Department Procedures Manual. Listed below are the forms necessary for establishing a student/surrogate parent relationship.


School or Agency requesting the appointment of a surrogate parent must complete this form. It is important that we have the name of the individual submitting the paperwork so that if a question arises, we will know whom to contact. If parents’ whereabouts are unknown, documentation is required substantiating efforts to locate them.


Surrogate parent applicant must complete this form. It is important that the applicant be fully informed and understands the rights and responsibilities of a surrogate parent. The Surrogate Parent Question and Answer document from the Oregon Department of Education may serve this purpose.

If parent gives the district responsibility for selecting a surrogate parent, the school or agency will find a suitable candidate and have him/her complete the Surrogate Parent Application form.

Confirmation of Court Wardship

Memo: Parent Authorizing Surrogate Parent

Memo: Student Authorizing Surrogate Parent