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(A) Sample Letter – Referral for Assessment

(A) Sample Letter – Referral for Assessment

Yolanda Bleu
City, State, Zip Code
Telephone Number


Victor Verde
Director of Special Education
Local Unified School District
City, CA Zip Code

Re: Max Bleu

Dear Mr. Verde:

I am writing to refer my son, Max, for assessment to determine if he is eligible for special education services and support. He is not progressing in school. He is seven years old and attends Harvey Milk Elementary School (child’s school of attendance).

(If you believe that your child may be eligible in particular categories, especially Other Health Impairment, Emotional Disturbance or Autism, you should specifically say so and ask that the assessment address those conditions. A standard special educational assessment looks at cognition, psychological processing and academic achievement, none of which may be deficient in a student qualifying in one of the above three categories.)

(If you have specialized knowledge or know specific tests, you might add🙂

I request that the Local Unified School District (your District) conduct the following evaluations of my son:

(1) A psychological evaluation to determine his learning potential, using instruments designed for non-oral children such as the Leiter International Performance Scale-Third Edition or the Hiskey Nebraska Test of Learning Aptitude;

(2) An evaluation by a non-oral communications specialist. To my knowledge, the district does not have on staff any experts in this field. I have been recommended to Barbara Blanco, Ph.D. in non-oral communication, and unless the district has a comparable expert, I am requesting that you contract with Dr. Blanco to do the non-oral communication evaluation of my son;

(3) An occupational therapy assessment.

In every request for initial assessment, you should include a paragraph requesting that your child also be evaluated under the provisions of Section 504 of the Rehabilitation Act of 1973 (Section 504) for any “disabling condition” which would require service accommodations and/or services that will allow the child to benefit from public education to the extent that students without disabilities do. (However, do not agree to substitute a Section 504 assessment for a special education assessment.) Such a paragraph might read as follows:

I also request that my son be evaluated under Section 504 of the Rehabilitation Act of 1973, pursuant to title 34 C.F.R. Sec. 104.35, for the presence of any educational service need which may require any accommodation or program modification not available under special education or if my child is not found eligible for special education. I also request that the Section 504 Coordinator for Local Unified School District be present at the initial IEP meeting to discuss the results and recommendations of the Section 504 Evaluation.

I look forward to receiving an assessment plan in 15 days pursuant to Education Code Sec. 56321(a). I hope that these evaluations can be completed promptly. Thereafter, we can have an IEP meeting to discuss the results of these evaluations and plan for John’s continued education. Please ensure that I get copies of the assessment reports one week before the IEP meeting.  Thank you.

Sincerely yours,

Yolanda Bleu