Create Your Own Referral Letter

Copy and paste the following text into MS WordTM
or other word processor


[Your Name]
[Your Address]
[Your Phone Number]
[Your Email Address]

Dear [Local Education Agency Representative],

I am writing to request an evaluation of my child for possible eligibility for special education and/or a 504 Plan. The reasons why I suspect my child may need accommodations and/or services are: [describe your child’s challenges with learning].

I appreciate the immediate receipt of an assessment plan as per the regulations. Please contact me at the email address indicated above with any questions about this request.

Regards,




[Your Name]