Physical Therapy Referral Letters Samples by jwz16865

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									                       Sample Referral for Special Education Evaluations

[DATE]

[For students who are in preschool, private school or are not enrolled]
[CHAIRPERSON]
[Committee on Special Education #____]
[ADDRESS]

[OR for students who attend public school]
[SCHOOL PSYCHOLOGIST]
[SCHOOL NAME]
[ADDRESS]

RE:    [NAME]
       DOB:______
       NYC ID #: ___________________

Dear [NAME]:

       I am writing to request that my child [NAME] be evaluated for school age special
education services.

       My child currently attends school at [P.S.___]. I have concerns because my child ....
[For example, “is in 5th grade but is reading at a 2nd grade reading level” or “has trouble
pronouncing words.”] My child’s teacher has mentioned to me that.... [For example, “my child
needs individualized attention to learn new concepts” or “is constantly out of his/her seat and
unable to focus.”]

        Specifically, I request that [NAME] receive a psycho-educational evaluation, social
history and [OCCUPATIONAL THERAPY/PHYSICAL THERAPY/ SPEECH &
LANGUAGE EVALUATION, ETC].

       Please contact me at the following address to arrange for evaluations:

                      [ADDRESS AND PHONE]

        I also ask that the Committee on Special Education convene a meeting to review my
child’s case as soon as the requested evaluations are complete. Please contact me at [NUMBER]
to schedule the review meeting.

Sincerely,

[NAME]
Parent

								
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