Request for Prior Written Notice/Disagreement with IEP

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:

My/our child (name of child), is a resident of (name of district). Currently, (name of child) attends (school, class, program, etc.). (Name of child) has (brief description of disability) and qualifies for special education services under the Individuals with Disabilities Education Improvement Act (IDEIA).

(Describe the problem. If there are several, list and number them separately. Include facts and dates if you have them.)(Describe the steps you have taken to resolve the problem(s): who you talked to, when, what happened, etc. This might include meetings you have had, letters you have written, agreements you thought were made, etc. Make specific requests for solving the problem(s) and include any information that supports your position.)
  1. (Problem) 
  2. (Problem)
  3. (Problem)
  4. (Problem)
  5. (Problem)
I/we understand that under the IDEIA, I/we have the right to prior written notice anytime the school district proposes or refuses to initiate or change the identification, evaluation or educational placement, or the provision of a free and appropriate education to my/our child.
Please provide me/us with a written response to my/our request by (list date by when you want a response; usually 10 working days is more than reasonable).  I/we appreciate your continued effort in (child’s name) educational progress.

Sincerely,

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

cc: Student's Permanent School File