Initial Request for Special Education Services

Make sure you have proof that you gave this to your school or district office. Ask them to put a time and date/stamp on it, and give you a photocopy after it has been stamped. Also, make sure you put it in a safe place; you may need it in the future.

(Today’s date)

(Special Education Director)
(School Principal)
(School Name)
(School Address)
(School City, State and Zip)
(School Telephone number)

Subject: (child’s name and date of birth)

To whom it may concern:

I am requesting (child’s name) is formally assessed for special education services. (Child’s name) resides in (name of school district) and attends (name of school).

I suspect that (child’s name) might have a disability that impacts (him or her) in the educational environment.  (Child’s name) seems to be having difficulty with (describe the child’s area of difficulty).
According to the IDEIA and California Education Code, a school district is required to assess a child who is suspected of having a disability.

Please contact me so that we can sign an assessment plan. Thank you for your efforts in (Child’s Name) educational progress.


(Your name)
(Your address)
(Your city, state and zip)
(Your phone number)

cc: Student's Permanent School File