SAMPLE LETTER TO REQUEST 504/IEP SERVICES
Parent/Guardian Name
Address
City, State, Zip Code
Daytime Telephone
Date
Name of School Psychologist and Principal and/or Special Education Director
Local School District/School
Address
City, State, Zip Code
Reference: (student’s name) (DOB: xx/xx/xx and grade level: xx)
Dear :
I am the parent/guardian of (student’s name), who is a student at (name of school). I am requesting a comprehensive assessment in all areas related to the suspected disability to determine whether (student’s name) is eligible for special education and/or related services either under the Individuals with Disabilities Act (including the Other Health Impairment category) or Section 504 of the Rehabilitation Act of 1973.
Since (date/grade) I have been concerned about (student’s first name) performance in the areas of (be specific-for example: test performance, attention, auditory processing, memory, reading, math, etc). Over the years, teachers have also noted concerns regarding (areas of concern). The following interventions and accommodations have already been tried (examples might be preferential seating, tutoring, testing accommodations, etc). However, (student’s first name) continues to struggle in school with (be specific-consistent grades, test performance, attention, organization, etc). If applicable add: In addition, (student’s first name) has been diagnosed with (specific diagnosis) by (professional/title). A written copy of that diagnosis/assessment is attached to this letter.
I understand that I can expect to hear back from you in writing within 15 days of this request. Thank you very much for your time and consideration. I look forward to working with you and other school staff to ensure (student’s name) success.
Sincerely,
Your name
Cc: (appropriate members of the student’s educational team)