Sample Advocacy Letters

Family Resource Network

The Family Resource Network is dedicated to supporting families through provision of information and support. We accomplish this through trainings, our library and sample letters that may be used to request a particular service or evaluation.

Documenting Your Attempts to Reach an Administrator, Teacher, or Staff Member by Phone

Date

Name
Address

Re: (Child’s name, d.o.b.)

Dear _________________,

I have made ________(#) of attempts to reach you by phone on ______, ________, ______ (dates you called and left messages) none of which have been successful. I would like to speak to you regarding my ___________(son/daughter’s)
____________________________________________________________________(issue).

Please contact me as soon as possible using the contact information below.

Sincerely,

Name
Address
Phone Number
E-mail address

Cc: (The supervisor of the person who has not been returning your calls)

Sample Letter Provided by Family Resource Network, Inc.

Jonathan's Law - Access to Abuse Investigations Sample

Your address
Your phone number

Date

Records Access Officer
Name of Provider serving the individual where abuse is alleged to have occurred
[or]
State Agency that conducted an investigation (e.g. Office of Mental Health, Commission on Quality of Care, OMRDD, etc)

RE: Request for Access to Records Pertaining to Allegations and Investigations of Abuse and Mistreatment of Name of person receiving services: (his or her date of birth) Pursuant to Article 33 of the Mental Hygiene Law

Dear Records Officer:

I would like to review all records pertaining to your agency’s investigations into allegations of abuse and mistreatment of name of person by [your agency or name of agency providing services where abuse occurred] from May 6, 2007 through the date of this request. Please contact me at the phone number or address above and advise me of specific dates and times when I can have access to said records. I may wish to copy some or all of the records, so please ensure that a means of copying is available. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page.

[or]

Please provide me copies of the all records pertaining to your agency’s investigations into allegations of abuse and mistreatment of name of person by [your agency or name of agency providing services where abuse occurred] from May 6, 2007 through the date of this request. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page. However, if the fee for copying said records and reports will exceed $XX.00, please contact me before any copies are made.

I am a “qualified person” to receive access to these records because I am the ([choose one]parent, legal guardian, spouse, adult daughter, adult son) of name of person receiving services, and I have the authority to provide consent for his/her care and treatment pursuant to the enclosed (choose one:)
If person is under 18 and you are parent, copy of his or her birth certificate or adoption papers identifying you as parent
If person is under 18 and you are legal guardian, copy of court order naming you legal guardian
If person is 18 or older, copy of court order naming you legal guardian
If person’s spouse, copy of marriage certificate
If person’s adult child, copy of your birth certificate and copy of court order giving you legal authority to make health care decisions for the person
[or]
the individual receiving services.

Thank you for your attention to this matter. I look forward to hearing from you within ten (10) business days.

Sincerely,

Signature
Printed name

Enc.

Sample Letter

222 Western Avenue
Nowhere, NY 00000
(000)-000-0000

March 1, 2008

Records Access Officer
NYS Commission on Quality of Care and
Advocacy for Persons with Disabilities
401 State Street
Schenectady , NY 12305

RE: Request for Access to Records Pertaining to Allegations of Abuse and Mistreatment of John R. Doe (DOB: 12/31/80) Pursuant to Article 33 of the Mental Hygiene Law

Dear Records Officer:

Please provide me with copies of all records pertaining to your agency’s investigations into abuse and mistreatment of John R. Doe by ACME Care Services from May 6, 2007 through the date of this request. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page. However, if the fee for copying said records and reports will exceed $15.00, please contact me before any copies are made.

I am a “qualified person” to receive access to these records because I am the parent and legal guardian of John R. Doe, and I have the authority to provide consent for his care and treatment pursuant to the enclosed copy of an Order of the Surrogate Court of Nowhere County appointing me Guardian pursuant to article 17-A of the Surrogate�s Courts Procedures Act.

Thank you for your attention to this matter. I look forward to hearing from you within ten (10) business days.

Sincerely,

Signature
Printed name

Enc.

Special Note:

Prior to using the above sample letter, please read the helpful information at the following link:

https://www.cqcapd.https://www.cqcapd.state.ny.us/Brochures/Access-to-MH-Records.htm

Sample Letter Provided by Family Resource Network, Inc.

Jonathan's Law - Access to Clinical Records Sample

Your address
Your phone number

Date

Records Manager
Provider Name (agency providing services)
Address

RE: Request for Access to Records of Name of person receiving services:(his or her date of birth) Pursuant to Article 33 of the Mental Hygiene Law

Dear Records Manager:

I would like to review all clinical records, incident reports, and reports on actions taken, if any, pertaining to name of person receiving services from the date he/she began receiving services from your agency in month/year through the date of this request. Please contact me at the phone number or address above and advise me of specific dates and times when I can have access to said records. I may wish to copy some or all of the records, so please ensure that a means of copying is available. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page.

[or]

Please provide me copies of the clinical records, incident reports, and reports on actions taken, if any, pertaining to name of person receiving services from the date he/she began receiving services from your agency in month/year through the date of this request. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page. However, if the fee for copying said records and reports will exceed $XX.00, please contact me before any copies are made.

I am a “qualified person” to receive access to these records because I am the ([choose one]parent, legal guardian, spouse, adult daughter, adult son) of name of person receiving services, and I have the authority to provide consent for his/her care and treatment pursuant to the enclosed (choose one:)
If person is under 18 and you are parent, copy of his or her birth certificate or adoption papers identifying you as parent
If person is under 18 and you are legal guardian, copy of court order naming you legal guardian
If person is 18 or older, copy of court order naming you legal guardian
If person’s spouse, copy of marriage certificate
If person’s adult child, copy of your birth certificate and copy of court order giving you legal authority to make health care decisions for the person
[or]
the individual receiving services.

Thank you for your attention to this matter. I look forward to hearing from you within ten (10) business days.

Sincerely,

Signature
Printed name

Enc.

Sample Letter

222 Western Avenue
Nowhere, NY 00000
(000)-000-0000

March 1, 2008

Records Manager
ACME Care Services
0000 Main Street
Anywhere, NY 00001

RE: Request for Access to Records John R. Doe (DOB: 12/31/95) Pursuant to Article 33 of the Mental Hygiene Law

Dear Records Manager:

I would like to review all clinical records, incident reports, and reports on actions taken, if any, pertaining to John R Doe from the date John began receiving services from your agency in June 2004 through the date of this request. Please contact me at the phone number or address above and advise me of specific dates and times when I can have access to said records. I may wish to copy some or all of the records, so please ensure that a means of copying is available. I understand that I will be charged a reasonable fee for copies, not to exceed $0.75 per page.

I am a “qualified person” to receive access to these records because I am John’s legal guardian, and I have the authority to provide consent for his care and treatment pursuant to the enclosed Order of the Surrogate’s Court of Nowhere County.

Thank you for your attention to this matter. I look forward to hearing from you within ten (10) business days.

Sincerely,

Signature
Jane Smith

Enc.

Special Note:

Prior to using the above sample letter, please read the helpful information at the following link:

https://www.cqcapd.https://www.cqcapd.state.ny.us/Brochures/Access-to-MH-Records.htm

Sample Letter Provided by Family Resource Network, Inc.

Sample FOIA Request Letter

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

Pursuant to the Michigan Freedom of Information Act, please provide me with the following information, in whatever form and wherever stored:

  1. Policies describing or discussing the (name of school) District’s provision of educational services in settings other than the regular or special education classroom or building.
  2. Complete descriptions of services provided within the last three school years in alternative educational settings, including but not limited to, private schools, community locations and private homes.
  3. Policies describing or discussing (Name of School) District criteria and implementation of providing special education services to students in alternative (non-classroom) settings.
  4. Any other written or recorded information discussing or implementing non-classroom educational services of any type within the last three school years, including number of students served and identifying the service venue, without identifying individual students.

Pursuant to the fee waiver provisions of FOIA, I request that the fee for fulfilling this request be waived because the material requested is of interest to the general public; and the information will be used for the benefit of the public. If fees are not waived please advise me of any anticipated costs exceeding $50.00 so that payment arrangements can be made pending appeal of the waiver denial.

Very truly yours,

 

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter - Disability Harassment

Your Mailing Address
Your email address (optional)

Date

Name of School Principal
Address

RE: Name of Child: (Date of Birth) NOTICE

Dear (Principal):

I am writing to report that my child is being harassed in school because of his/her disability. As you know, my child has a (IEP or 504 plan) based on (specify the diagnosis or disability). The following is a list of some of the acts of harassment name of child has experienced.

• List each incident in order of when it happened. Include details about who was involved, what happened, where and when it occurred. Describe the impact of the incident on your child. Note any witnesses if there were any.

I have attempted to resolve my concerns by (explain how you have tried to resolve the problem, who you talked to, and any response to your concerns).

I am requesting that you take immediate steps to end this harassment and to prevent it from happening again. Please provide me with written notice of the actions you will take to keep my child safe and address the harassment. If you are unable to provide a written response and description of proposed actions, please indicate in writing when I can expect to receive them.

In addition, I am requesting a meeting of the Committee on Special Education (CSE) to discuss how to protect my child and how to address the effects of the harassment on child’s name. I can arrange to meet with you and the CSE on (list days you are available) between (give a range of time, such as between 2:00 and 4:00). Please let me know the earliest date available.

(Optional) Each day that passes is another day that my son/daughter remains unsafe. Therefore, if I do not hear from you promptly, I will be left with no choice but to file a complaint with the Office of Civil Rights.

Thank you for your attention to this matter. I look forward to working with you to resolve these problems.

Sincerely,

Your Name

cc:
Name of President of Board of Education
Address
(this info can usually be found on school website)

Name of Superintendent
Address

Name of CSE Chairperson
Address

 

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Giving IEP Team Meeting Dates

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name) [date of birth] attends (school name). On (date of request), we sent a letter asking for a comprehensive educational evaluation. This letter is to tell you of our IEPC meeting availability dates. I can attend anytime on the following dates:

– April 7, 8, 9 and 11, 2003
– April 15, 17, and 18, 2003
– April 21, 22 and 23, 2003

Please choose from the dates I have listed and let me know as soon as possible. I look forward to attending and participating in (child’s name) IEP Team meeting. My employment travel allows me to hold the listed dates open for only one week (or list date). If these dates do not work for the school district, please send me a few dates that are available. I will need copies of all evaluations at least three school days before the IEPC meeting.

Thank you for giving this letter your immediate attention. I will work with you to address and achieve (child’s name) educational goals.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter of Understanding

Date

Name
Title
School District
Address
City, NY

Re: (Child’s name, d.o.b.)

Dear ___________________________,

On ________________________ (date of meeting) a meeting was held to discuss my ___________(son or daughter), _________________(child’s name). It is my understanding that _____________________________________________________(please outline the decisions made, follow up what was committed to, disagreements with any decisions made, restate any dates that were committed to i.e. any issues that were either resolved or not resolved)

Thank you for your time. If I do not hear back from you I will assume that my understanding is accurate. If your understanding differs from mine, please contact me using the information provided below.

Sincerely,

Parent’s name
Address
Phone number
E-mail address

 

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting an Assistive Technology Evaluation

Sample Letter Requesting an AT Evaluation
________________________________________
LETTER REQUESTING AN ASSISTIVE TECHNOLOGY EVALUATION

DATE

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

Because of my (son/daughter, Child’s name)’s history and diagnosis of (relevant diagnosis) I would like to request an Assistive Technology Evaluation.  This request is to determine, if any, the assistive technology (Child’s name) may benefit from.

I believe that (Child’s name) may benefit from the use of assistive technology in the following educational areas:

We understand that with your help in addressing this matter we can put together the most appropriate educational program for (Child’s name) to assist (him/her) in reaching (his/her) full potential. I am sure you are as concerned as we are to see him/her serviced properly.

Sincerely,

Sign Here

(Parent’s Name Typed)

 

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting an Autism Spectrum Disorder Evaluation

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name), (date of birth) attends (school name). I suspect that my child has an Autism Spectrum Disorder due to the following signs and symptoms that are consistent with ASD:
(List observed signs and symptoms consistent with ASD that have prompted you to initiate this request)

I am requesting that you evaluate my child in the area related to the suspected disability by a specialist with knowledge in diagnosing Autism Spectrum Disorders. I believe this information is needed to plan an appropriate educational program for my child.

Please inform me in writing within seven days whether you intend to honor my request.

Thank you and I look forward to hearing from you soon.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Change in Child's Records

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name) [date of birth] attends (school name). There is a statement in (child’s name) (give name of record. For example, “physical therapy evaluation, performed by Ms. Wormwood on June 5, 1999)” that I believe is (“misleading”, “inaccurate”, and or “in violation of my child’s rights”) because (give your reasons).

I request that you change (child’s name) (name of record) records so they will no longer be (“misleading”, “inaccurate”, and or “in violation of my child’s rights”) because (give your reasons).

I look forward to your prompt response to this letter.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting a Due Process Hearing

Your Street Address
City, State, Zip Code
Date

Name of Person You Identified
Title
Name of Organization
Street Address
City, State, Zip Code

Dear Ms./Mr. (Name of person identified):

I am requesting a due process hearing to resolve a dispute with (Name of your town) school system. My child, (Child’s name), is in (Grade level/special education classroom) at (School name). He was born on (Date of birth).

I have met with (Names of school personnel) in an effort to resolve our differences with my child’s (IEP, placement, testing, or whatever) and have been unable to do so.

Please advise me as soon as possible as to the date and time of this hearing so that I can make the necessary arrangements with work (or childcare) and with those people we wish to include in the hearing. My daytime telephone number is (000) 000-0000.

I also request that this hearing be open/closed to persons other than those directly involved. (Name of child) will/will not attend the hearing.

I look forward to hearing from you as soon as possible. Thank you for your help in this matter.

Sincerely,
(Your signature)

(Your name)

cc: (Name), Director of Special Education
(Name of your attorney/advocate)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Extended School Year

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

As I promised, I have enclosed some material, which will be helpful to you in explaining to __________ IEP Team why it is critical that ________ receive summer services at the district’s expense.

As we discussed, it is likely that the district will focus on the regression/recoupment standard based upon their belief that this is the only standard utilized in determining whether extended school year services are justifiable. However, as you will read in the attachment, regression is not the only factor that can be relied upon in the ESY decision. Courts have identified six factors that may be relied upon to make this determination.

While regression/recoupment is an important consideration, the Team must also consider:

– degree of progress towards IEP goals and objectives;
– emerging skills or breakthrough opportunities that will be lost over the long summer months;
– any behavior that would interfere with your child’s ability to benefit from special education.
– the nature and severity of the disability; and
– the child’s ability to benefit from special education.

Because _______’s needs are extensive, based upon his diagnosis of autism, it is critical that he receive consistent instruction 12 months a year without interruption. _______’s future independence is wholly based upon his ability to effectively communicate. His speech and language deficits unquestionably necessitate summer instruction, so that he not only maintains the skills that he has acquired during the school year, but continues to progress in an effort to catch up to his typical peers.

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Functional Assessment of Behavior and Positive Behavior Support Plan

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name) (date of birth) attends (school name). I believe that (child’s name) behavior is beginning to interfere with his/her ability to learn and to reach his/her IEP goals and objectives. The following difficulties support my concern:

(List your observations – here are some examples)
– S/he does not know how to respond constructively to name calling or teasing;
– S/he is not cooperative in groups;
– S/he needs assistance to distinguish between socially acceptable and unacceptable behavioral responses to various situations and environments;
– S/he does not recognize situations in his/her self-control is needed;
– S/he does not know how to cope with stress-provoking situations he/she cannot avoid;
– S/he does not understand the consequences of appropriate and inappropriate expressions of his/her feelings.

Please provide (child’s name) with a functional assessment of behavior as is required by the Individuals with Disabilities Education Act [IDEA]. Please consider this letter my formal request for and consent for the school district to provide the functional assessment. I understand that a positive behavior support team will be assembled to review the functional assessment of behavior and develop an appropriate behavior intervention plan. I expect to be included in the functional assessment of behavior and as active participant on the team developing the behavior intervention plan Please provide me with copies of all FBA data and results as soon as they become available to you. I hope that this request can be expedited as (child’s name) already has been suspended in/from school on (number of times) for a total of (number of days) days.

Thank you for giving this request for a functional assessment of behavior your immediate attention. I will work with you to address and achieve (child’s name) educational goals using positive behavior support and an effective behavior intervention plan.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting an IEP Team Meeting

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name) (date of birth) attends (school name). My child’s IEP Team has not yet met for this year. Please schedule an IEP Team meeting as soon as possible to write my child’s IEP. Please contact me so that the meeting can be scheduled at a mutually agreeable time and place. Before the meeting, please send me a copy of the school’s IEP form.

Thank you for your help. I look forward to hearing from you soon on this matter.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting an IEP Team to Review and Revise a School Program

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

I am the parent and guardian of (child’s name) (date of birth) who attends (school name). My child is experiencing difficulties at school (List the difficulties your child is experiencing).

I am writing to request that an IEP Team meeting be convened to address these difficulties and revise (child’s name) IEP. Please ask the following people to attend the IEP Team meeting: (List the people you think are important to have at the meeting).

Please contact me to discuss a date and time for the IEP Team meeting.

Thank you for your help. I look forward to hearing from you soon on this matter.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting an Independent Evaluation

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name) (date of birth) attends (school name). I disagree with the results of the school district evaluation of (child’s name) on (date) because (reason why you feel the tests were invalid, inadequate or not an accurate measure of your child’s performance).

I request an independent evaluation to obtain the valid and reliable information I believe is needed to plan an appropriate educational program for my child. Please send me information on:

– Criteria for qualified examiners;
– Suggested sources and locations;
– Procedures for reimbursement;
and
– Reasonable and expected costs.

I understand that the school must pay for the independent evaluation unless it can prove in a due process hearing that its assessment is appropriate. Please inform me in writing within seven days whether you intend to honor my request or to request a hearing on the issue.

I will forward the results of the evaluation to you since, as I understand it, the results of an independent evaluation must be considered in any future decisions about my child.

Thank you and I look forward to hearing from you soon.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Medical Records

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

Re: Child’s name and date of birth

Dear

My son, (child’s name), is your patient. We realize that (child’s name) medical needs are on-going, and that we as his parents have an on-going obligation to be sure that he receives the best care available, regardless of where we live or work. In order for us to be best prepared to help (child’s name), we need to maintain a set of his medical records and to compile a medical resume for use with his various professional specialists, care providers and teachers.

Would you please provide us with copies of all medical records you have concerning (child’s name), from your first date of treatment to the present? We also would like to arrange that we receive copies of on-going medical records at least once every three months. What do we need to do to arrange that with you?

Thank you for understanding the need for our request and for your prompt response.

Sincerely

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting a Neuropsychological Evaluation

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

I appreciated the opportunity to meet with you on (date of meeting).

I was pleased that you agreed to my request for an Independent Educational Evaluation for my child, (child’s name).

Because of my child’s neurological history (a copy of his most recent EEG is enclosed) and his continuing Phenytoin therapy, I am requesting a psychological evaluation by a practitioner with a background in neurological disorders. I would like the evaluation to detect the presence of an organic brain dysfunction, the nature of the problem, the extent of the problem and how it impacts my child’s educational performance.

I believe it is important to attempt to isolate the problem area and develop compensatory strategies to bypass the problem. We want to know why there is such a disparity between his school psychological evaluation and his report card, and specifically, why he is so poorly organized.

I request testing to measure his thinking ability, memory ability, speech and language ability, motor ability, sensory and perceptual ability and personality testing. I would like the evaluation to specifically include the Halstead-Reitan test battery which I am sure you are aware, is a series of memory tests, language-based tests, visual-memory based tests and tactile memory tests, as well as the Speech Sounds Perception test battery, which zeros in on phenic ability.

As you requested of me at our meeting, here are the names of three acceptable evaluators:

To avoid confusion, please send me the criteria regarding credentials for qualified examiners. I am anxious to receive your list of suggested sources and locations, procedures for reimbursement, as well as to arrange a reasonable, expected cost. I am looking forward to receiving the above requested information and I am aware that I am not restricted to your suggested sources but will, of course, inform you as soon as I make my decision.

We are most anxious to move forward with this plan so that we can put together the most appropriate educational program for our child to assist him in reaching his full potential. I am sure you are as concerned as we are to see him serviced properly.

Sincerely,

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Organizational Evaluation

Dear (Name of Special Education Director):

My child, (child’s name) (date of birth) attends (school name). I am concerned that he lacks self-management skills as a result of his disability. I believe the lack of these skills is having a devastating effect on his academic performance. Here are some of the symptoms he exhibits that support my concern.

– He has poor time-management skills;
– He does not know how to take classroom notes;
– He does not know how to organize his notebooks;
– He has test anxiety and “shuts down” due to fear of failure.

Because (child’s name) has great difficulty paying attention he is not able to focus on new information long enough to make it a part of his working memory. He has problems handing in homework on time and getting to class on time. Because of his organizational difficulties he has trouble remembering what he has read and difficulty writing a satisfactory report.

I read that self-management skills are considered to be part of the brain’s “executive functioning” and that the frontal lobe of the brain is the “command center” for goal-directed behavior. I understand that executive functioning is a complex process that enables the student to see a task through from beginning to end by coordinating multiple processes, starting and stopping mental operations, and maintaining motivation and persistence.

Please evaluate (child’s name) under the Individuals with Disabilities Education Act [IDEA] and Section 504 of the Rehabilitation Act to see how his disability is related to the above problems, to see what goals and objectives are recommended to address those problems in light of his disability, and to see what, if any, related services are necessary.

Please consider this letter my consent to evaluate (child’s name) for special education needs and services. Obviously (child’s name), the school district and I will feel much better once we understand what is going on with him. I would appreciate it if you would schedule the evaluations as quickly as possible. Please call me at home to arrange times and places. I will need my copies of all written evaluations at least three school days before the IEP Team meeting. I will advise you of my IEP Team meeting availability dates by separate letter.

Thank you for giving (child’s name) evaluations your immediate attention. I will work with you to address and achieve his educational goals.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Prior Written Notice

Dear _____,

As the minutes of (name of child) CSE meeting on (date) of this year should show, I requested written Prior Notice of the district’s refusal to provide ________,

As stated in part 200.5 (Due process procedures) of the Regulations of the Commissioner of Education, “written prior notice of a change in services must be given in a reasonable time before the school district proposes to or refuses to initiate or change the identification, evaluation, educational placement of the student or the provision of a free appropriate public education.”

This notice must include:
(i) a description of the action proposed or refused by the district;
(ii) an explanation of why the district proposes or refuses to take the action;
(iii) a description of any other options that the district considered and the reasons why those options were rejected;
(iv) a description of each evaluation procedure, test, record, or report the district used as a basis for the proposed or refused action;
(v) a description of any other factors that are relevant to the district’s proposal or refusal;
(vi) a statement that the parents of a student with a disability have protection under the procedural safeguards of this part, and the means by which a copy of a description of the procedural; safeguards can be obtained;
and
(vii) sources for parents to contact to obtain assistance in understanding the provisions in this part.

I believe that the district has had ample time to respond to my request, and would appreciate hearing from your office on this matter within 48 hours from receipt of this communication.

Thank you,

____________

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Re-Evaluation

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name) (date of birth) attends (school name). I recently reviewed my child’s evaluation and it is (out-of-date, incomplete, inappropriate due to change in seizure control, time for a three year evaluation). I request that my child be re-evaluated. Please tell me in writing who will be doing the evaluation and when it will be scheduled.

Thank you for your help. I look forward to hearing from you soon.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Records From School District

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name) [date of birth] receives special education services at (school name). Please provide me with a complete list of all education records you have on my child. Please tell me where those records are kept, and whom I should contact so I can look at them and have copies made.

If (name of schools district) has produced any written material about access to student records pursuant to the federal Family Education Rights and Privacy Act, I would request that you send me a copy of that as well.

Thank you for your help. I look forward to your prompt response.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Referral for Initial Evaluation

PARENT’S NAME
ADDRESS
CITY, STATE ZIP CODE
TELEPHONE NUMBER

Date

(Name of Special Education Director)
(Name of School District)
(Address of School)

Dear (Name of Special Education Director):

My child, (child’s name) (date of birth) attends (school name). I believe that s/he might have unidentified disabilities. The following difficulties support my concern:

(List your observations – here are some examples)
– S/he does not respond normally to sensory input;
– S/he shows no desire to explore her environment through touch;
– S/he has difficulty holding a pen or pencil with a mature grasp;
– S/he has difficulty when applying decoding skills when writing; and
– S/he has poor short-term memory.

Please evaluate (child’s name) under the Individuals with Disabilities Education Act [IDEA] and Section 504 of the Rehabilitation Act to see if s/he has a disability and if related services are necessary. Please consider this letter my consent to evaluate (child’s name) for special education needs and services. It is my understanding that the District must complete the evaluation and determination process within 60 days from the date of consent. If the District requires consent in addition to the consent given in this letter, please provide me with the required consent form within 3 business days so that we can move forward expeditiously.

Please call me at home to arrange times and places. I will need my copies of all written evaluations at least three school days before the IEP Team meeting. I will advise you of my IEP Team meeting availability dates by separate letter.

Thank you for giving (child’s name) evaluations your immediate attention. I will work with you to address and achieve (child’s name) educational goals.

Sincerely,

(Your name)
(Your address)
(Your telephone number)

Sample Letter Provided by Family Resource Network, Inc.

Sample Letter Requesting Sensory Integration

DATE

Dear

We are the parents of (child’s name) and believe that he might have unidentified disabilities. We suspect that (child’s name) may suffer from a neural disorder that causes the nervous system to receive incoming information, via the senses, in an inefficient manner. The following difficulties support our concern: (child’s name) is oversensitive to touch; unusual level of activity; impulsive; lacking in self-control; inability to unwind or calm himself; delay in academic achievement; behavioral challenges and poor self-concept.

“In the classroom a student is easily distracted by all the extraneous sounds, lights, and the confusion of many people doing different things. His brain is over stimulated and it responds with a lot of excessive activity. If he is standing in line and someone accidentally bumps into him, he may become angry or strike back. The anger and hitting have nothing to do with interpersonal relationships; they are automatic reactions to sensations the child cannot tolerate.” Sears, Carol J., “The Tactilely Defensive Child,” in Academic Therapy, May 1991

We request a complete educational evaluation and an evaluation to detect if a sensory integrative disorder exists and if related services are necessary. Please schedule these evaluations in compliance with the Individuals with Disabilities Educations Act [IDEA] and Section 504 of the Rehabilitation Act. Please consider this letter my consent to evaluate (child’s name) for special education needs and services. Obviously (child’s name), the school district and we will feel much better once we have an understanding of what is going on with (child’s name), so we would appreciate it if you would schedule the evaluations as quickly as possible. Please call me at home to arrange times and places. I will need my copies of all evaluations at least three school days before the IEPC meeting, and will advise you of my IEPC availability dates by separate letter.

Thank you for giving this letter your immediate attention. I will work with you to address and achieve (child’s name) educational goals.

Sincerely,

Sample Letter Provided by Family Resource Network, Inc.

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Individuals with special needs deserve every opportunity to achieve their unique potential. The Family Resource Network was founded by parents to enhance the lives of individuals with special needs and their families, empowering them to lead productive independent lives within the community.