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

Replace the information in brackets (“[” and “]”) with the appropriate relevant information:

[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 within the next 15 calendar days, as per the regulations. Please contact me via email with any questions about this request at the email address stated above.


[Your Name]