Your Full Return Address
Date

Name of Principal
School Address

Dear (Name of Principal):

I am the parent of ______________, whose date of birth is _____________ and who is a student in the ___________ grade.

Because my child has not been doing well in school, I am requesting that s/he be evaluated to determine his/her eligibility for services under the Individuals with Disabilities Education Act (IDEA) and/or Section 504 of the Rehabilitation Act of 1973.

I am particularly concerned about (List all areas you see producing problems at school that you wish to be considered, such as failing grades, inattentiveness, distractibility, inability to follow directions, problems completing school work, disorganization, behavior or social problems, etc.). I would like to schedule this evaluation as soon as possible to determine the impact of ______________'s difficulties on his/her ability to learn or benefit from his/her educational program.

Before the evaluation, I would like to know more about the tests to be given, the testing process, and the date of the evaluation. I would like to know the name of the evaluator and the person who will observe _____________ under classroom conditions. I believe it will be important that the evaluation will include a complete assessment to rule out the possibility of a learning disability.

I understand that under state regulations, I am a member of the multidisciplinary team (MDT). I will be happy to provide information about my child's history, strengths and needs to other members of the team.

I hereby give my consent for the evaluation to be conducted. I understand that under state regulations, the evaluation and Evaluation Report must be provided to me within 60 school days from the day of my consent.

I believe that, by working together, we can help _____________ experience success in school. If you have any questions about this request, please contact me during the day at (daytime phone number). Thank you.

Sincerely,

Your Name (Keep a copy of this letter for your files.)