FORM FOR REQUESTING RECORDS
Parent
Address
City, State, Zip
Telephone Number
Fax Number
Email Address
Date
Special Education Director
School
District
Address
City/State/Zip
Reference:
Request for Records of [Child’s Name]; DOB; School
Dear Special Education Director:
I am the parent of ___________. I am requesting a copy of my child’s school records. Please send a
complete copy of my child’s cumulative and confidential education records maintained by the school
and/or cooperative concerning ___________________, including the following:
1.
Individual Education Plan (“IEP”) or 504 Plan, including all Admission, Review and
Dismissal (“ARD”) Committee meeting minutes, deliberation notes, present levels of
academic performance/functional performance (“PLAP/FP”), goals and objectives.
2.
IEP/504 Progress Reports and notes, including any data used to produce such reports;
3.
Referrals for, and all Full and Individual Evaluations (“FIE”) performed, including any
notes, data and reports;
4.
Individual Educational Evaluations (“IEE”) used, or considered, by the ARD Committee;
5.
Functional Behavioral Assessments (“FBA”), Behavioral Intervention Plans (“BIP”) and
any notes, records or data used to create the same, including any Manifestation
Determination Review (“MDR”) data, notes or related documentation;
6.
Psychological testing and evaluations, including protocols and comparative reports;
7.
Report cards and deficiency notices;
8.
Benchmark testing, 360 data, TASKS/STAAR standardized, achievement, and ability
testing results, including protocols and reports showing how my child performed
compared to peers;
9.
Therapy files, such as Occupational Therapy (“OT”), Physical (“PT”), Adaptive, and any
other therapeutic files, including evaluations and progress notes;
10.
Medical records, nurse notes, or other medical information maintained by the school;
11.
Disciplinary and attendance records, notes, and reports;
12.
PEIMS, TEAMS, or similar data reports and notes related to my child;
13.
Formal or informal memos, observation notes, or other correspondence, including any
audio/video recordings by general and/or special education teachers, aides,
paraprofessionals, substitute teachers or any school staff or administrators, regarding my
child;
14.
Correspondence to and from parents, awards, notices of placement and statement of
rights that were provided to parents and copies of notes or documents provided to
Medicaid auditors in regard to this child or services provided to this child, copies of
Medicaid reimbursement claims made by this agency and/or school or county entity for
services provided or allegedly provided to my child.
Please provide the records in paper form or scanned as a PDF and saved to a CD. Because I am
requesting these documents for educational planning purposes, I would like to receive them as soon as
possible and certainly no more than 45 days after this request. Without complete school records, I cannot
participate in any meaningful way in planning my child’s education. If there are any costs or policies about
photocopies, please let me know immediately.
If you have any questions or need additional information, please call me at xxx-xxx-xxxx. Thank you for
your prompt attention to this matter. I appreciate your help and look forward to your response.
Respectfully,
Parent