SAMPLE – EVALUATION FOR SPECIAL EDUCATION/504 ELIGIBILITY REQUEST LETTER

_____________________

Parent name & address

_______________ ____, 20__

___________________________

Principal or Director of Special Education

Name & address

To Whom It May Concern:

I am requesting a special education evaluation for my child, _____________________________________, pursuant to the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act. Please consider this letter my full consent, as my child’s parent and/or guardian, to evaluate him/her in accordance with the IDEA and Section 504 of the Rehabilitation Act.

My child has the following diagnosis / diagnoses or symptoms ________________________________________________________________________

________________________________________________________________________

________________________________________________________________________.

As a result of my child’s problems, my child has experienced significant difficulties and I believe that s/he would benefit from a specialized supports in school. My specific concerns are: ________________________________________________________________________

________________________________________________________________________

Check one:

I understand that the school has 45 school days or 90 calendar days to evaluate my child and hold an eligibility meeting.

Because my child is currently subject to discipline (suspension, expulsion, or alternative school), I would like this evaluation to be expedited pursuant to 34 CFR Section 300.534(d)(2)(i).

Please contact me at ___________________________ if you have any questions or need additional information. Thank you.

Sincerely,

_____________________

Parent/Guardian