[Date]
[SCHOOL DISTRICT]
Attn: [SPECIAL EDUCATION DIRECTOR]
[SCHOOL ADDRESS]
RE: Request for Referral for an Evaluation (Possible IEP Needed)
Dear [DISTRICT PSYCHOLOGIST/CONTACT]:
I am the [PARENT] of [CHILD], a [WHAT GRADE] Grade student currently enrolled at
[A PRIVATE OR PUBLIC SCHOOL WITHIN THE DISTRICT & SCHOOL
ADDRESS]. I am writing to formally request a referral for an evaluation of my [CHILD]
because I’m concerned [HE/SHE] may have a qualifying disability [IF YOU SUSPECT
DISABILITY TYPE PLEASE INCLUDE A RECOGNIZED “QUALIFYING
DISABILTY”: Deaf-blindness, Deafness, Emotional disturbance, Hearing impairment,(Hard of
Hearing), Intellectual Disability, Multiple disabilities, Orthopedic impairment, Other health
impairment, Specific learning disability, Speech or language impairment, Traumatic brain injury,
Visual impairment], which may be contributing to [HIS/HER] challenges.
As such, I am formally requesting a referral for an Evaluation by [SCHOOL DISTRICT]
evaluators of [CHILD NAME] in all potential areas of disability, including cognitive
abilities, academic skills, language skills, and social-emotional needs. I am deeply
concerned that [CHILD NAME] may have a [INCLUDE QUALIFYING
DISABILITY] which would impede [HIS/HER] ability to learn. I understand that under
the Child Find law as well as IDEA and FAPE, public schools have an affirmative duty to
find all children within their district and refer the child to a qualified evaluator in order to
adhere to the Individualities with Disabilities Education Act so they can provide a Free
Appropriate Public Education.
I look forward to hearing from you regarding the assessment plan within 15 calendar days
from the date of this letter (34 CFR 300.304; EC 56321)
Please feel free to contact me at [YOUR PHONE NUMBER]
Thank you for your help,
[PARENT]
[HOME ADDRESS]
[SCHOOL OF ATTENDANCE ADDRESS]
[PHONE]
[EMAIL]
Cc:
[any education advocates or attorneys, current therapists, school principal]