Sample Letter of Referral for First Time Evaluation Requests

(Replace blue, bolded type with your information)

School Special Education Coordinator/Principal or Committee on Special Education Office (CSE)*

Address of CPSE/CSE Office

Child’s name, date of birth, name of school, ID, or OSIS#

Date

Dear Chairperson,

I am referring my child, name, for a full evaluation because I believe that my child may require special education programs or services. I would like the following evaluations to be conducted: psychological, psychoeducational, occupational therapy, physical therapy, speech and language pathology, functional behavioral assessment (include all evaluation requests, delete those not requested).

I am available to sign the consent to evaluate as soon as it’s available, and I look forward to hearing from you.

Sincerely,

Your name

Your address

Your telephone number

Notes:

• Keep a copy of the letter for your records.
• If you haven’t heard from the school or received the consent to evaluate within 10-14 days, contact them to follow up.
• Children who attend public school are evaluated by their school’s IEP Team. Children who attend private, charter, parochial, state-approved non-public schools, or are not in school are evaluated by the CPSE or CSE Office according to the district in which your child lives. Contact information for the CSE Offices can be found on the NYCDOE website.
• Evaluations are free of charge.
• Evaluations must be conducted in all areas of suspected disability and in the child’s native language.
• It may be helpful to attach a doctor’s note requesting specific evaluations.
• For more information about the referral and evaluation process, read INCLUDEnyc’s Special Education Timeline tip sheet.