Create Your Own Referral Letter

Just complete the form below and submit it to create a custom PDF that you can download and use to refer your child for an initial evaluation for special education and related services.

Please note: We will not sell your contact information to anyone, ever. We are a nonprofit organization committed to educational equity, not a marketing firm. You may receive notices from us in the future about important legislative actions and other serious issues related to special education, but you will never receive sales promotions from us.

Request for Initial Evaluation for Special Education

This form letter is for use by parents to refer their children for initial evaluations under the IDEA. Please note: We will not sell your contact information to anyone, ever. We are a nonprofit organization committed to educational equity, not a marketing firm. You may receive notices from us in the future about important legislative actions, such as this current threat to the IDEA, but you will never receive sales promotions from us.

Parent's Name*
First Last
Parent's Mailing Address*
Street Address Address Line 2 City State ZIP Code
Parent's Phone*
Parent's Email*
Name of Local Education Agency*
LEA Contact Person*
The name or title of the person at your local education agency to whom you are addressing this request; this is often a Special Education Program Coordinator, Director of Special Education, Assistant Superintendent of Educational Services, etc. If you are not sure, just leave it at the default "Special Education Director."
Local Education Agency Address*
Street Address Address Line 2 City State ZIP Code
Name of Student*
Student's Date of Birth*
Student's Current Grade Level*
Student's Current School of Attendance*
Parent Concerns*
Describe the things you are seeing that give you cause to suspect that your child may have a disability that is interfering with your child's learning, access to instruction, and/or ability to participate in school with other students appropriately.