Special Education Assessment Request Letter

There are three steps to creating a special education assessment request letter, appropriate for children ages 3-22 years old. [(For children under 3, see our early intervention program page.)]

  1. Look up the address of your local school - look up schools in Santa Clara County or look up schools anywhere in the USA.
  2. Copy and paste the letter below into your own word processing program for replacing the generic fields (those that are in bold) with your personal information and refinement.
  3. Please consider attending one of PHP's Individualized Education Plan (IEP) trainings so that you can become the best advocate for your child!


Sample Letter Request for an Initial Assessment
for Special Education Eligibility

Parent/Guardian’s name
City, State, Zip Code
Daytime Telephone


______________(Principal or Special Education Director)
Local School District
City, State, Zip Code

Dear _______________

I am the parent of__________ who is in the ___ grade at ____________(school). I am requesting a comprehensive assessment in all areas related to suspected disability to determine whether _______is eligible for special education and/or related services either under the Individuals with Disabilities Education Act (including the Other Health Impairment category) or Section 504 of the Rehabilitation Act of 1973.

I am requesting this assessment because __________________(be specific). The following interventions and accommodations have already been tried. (list interventions such as seating assignments, quiet area to take tests, etc.) However, my student continues to struggle in school with___________. If applicable add: ____________ has been diagnosed with__________ by __________(professional).        

It is my understanding that I will hear back from you in writing within 15 days of this request.

I look forward to hearing from you and working with you and your staff.


Your name

cc: include others who you think might need to know about your request.