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SAMPLE EVALUATION REQUEST

YOUR NAME

YOUR ADDRESS

YOUR PHONE NUMBER

                                                                                                                                      DATE 

PRINCIPAL
CHILD’S SCHOOL
ADDRESS

Dear (Principal’s name):

            I am the parent of ________________________, DOB________, a student at ___________________ in ___ grade.

             My child has not been doing well in school and I believe __________ may need special education services.  I am therefore requesting a complete Multi-Disciplinary Team (MDT) evaluation to determine if my child needs special education  and, is so, what programs and services are needed.  I understand that by law, I am a member of the MDT team, please let me know when the MDT will meet so that I may attend.

             I hereby give my consent for the evaluation to be done.  I understand that under state regulations, the evaluation must be completed, and I should receive a copy of the evaluation report within 60 calendar days from the date of my consent. Please send me the official school permission to evaluate form (T-700) within ten days, as prescribed by the PA Regulations and Standards, so that we can formalize the process.

             Should you have any questions with this request, please contact me at the above address and/or phone number.

             Thank you.

                                                                                                                   Sincerely,

                                                                                                            (YOUR NAME)

 cc:       Director of Special Education Services

* * REMEMBER TO KEEP A COPY FOR YOUR RECORDS!