Request for Services Letter

Directions: Remove the top two lines. Fill in the information asked between the []. Once completed, print out the letter and submit to your child's or teen's school office. Remember to use the proper form for writing a letter. Thank you!

----Start of the letter----

[Your name and complete mailing address]
[Today's Date]

To whom it may concern:

I am requesting an evaluation of Special Education services for my child [insert your child's full name] who is currently attending the [insert current grade level] at your school. [He/She] is currently assigned to [insert teacher's name]. [insert child's first name] was recently diagnosed by Dr. [insert doctor's name] on [insert calendar date] as having [insert diagnose(s)]. Currently, [he/she] has problems with [list disability characteristics not individuals].

Thank you for your help and cooperation.


[insert your full name]

----End of the letter----
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