Sample Letter – Referral for Special Education

From: Special Education Rights and Responsibilities, Ninth Edition by Protection and Advocacy, Inc. and Community Alliance for Special Education. Full text available at

Ms. Bev Blue
City, State, Zip Code
Telephone Number

Mr. Gary Green
Director of Special Education
Local Unified School District Address
City, State, Zip Code

Dear Mr. Green:

I am the parent of John Blue, who is currently enrolled at the Regular Elementary School in the fifth grade. My child has not been doing well in school and I am concerned about his educational progress.

I am writing to make a referral for assessment for special education services for John, as required by 5 C.C.R. Sec. 3021(a). He may be eligible for special education assistance. I am requesting that John be given a comprehensive assessment by the school district and that an IEP meeting be scheduled for him. [Optional: As part of the assessment process, I also request that my child be assessed under Section 504 of the Rehabilitation Act of 1973 to determine whether he should be identified as “handicapped” pursuant to that law and to determine what, if any, accommodations might be required in his educational program in the event that he does not qualify for special education services or in addition to special education services. This is also to request that the Unified School District’s Section 504 Coordinator be present at the IEP meeting to discuss the results and recommendations of the Section 504 assessment.]

I look forward to receiving an assessment plan within 15 days. If you have any questions, please feel free to contact me. Thank you for your cooperation and assistance.

Bev Blue