Request for Additional Evaluations for Student Already Receiving Special Education Services (#101en)

Form: Request for Additional Evaluations for Student Already Receiving Special Education Services

Instructions

Fill Out All Fields:
- Provide your name, the student’s name, and any other details requested.
- Please check your email address. The final letter and instructions will be sent there.
- Make sure to include 2 or 3 dates and times when you are available to sign the consent form.
Review Your Information Before Submitting:
- Make sure everything is spelled correctly and includes the details you want in your request letter.
Click “Submit”:
- After you submit, you will see a “Thank You” screen.
- This page will include a button to download the PDF of your request letter immediately.
Check Your Email:
- You will also receive an email with the same PDF letter attached.
- The body of the email will contain additional information and tips about next steps.
Use the Letter:
- Print or forward the PDF as needed.
- Keep a copy for your records to track your request and maintain documentation.
Date*

MonthDayYear
Case Manager or Principal Name*

First NameLast Name
School or School District's Name and Address*

School or School District Name

School or School District's Address

CityState

Zip Code
Child's First and Last Name*
Child's Grade*
Special Education Category Listed on the IEP*
How to Write Your Concerns

Use the sentence that’s already on the form.
- You will see “I think more evaluations are needed because I have the following concerns:” on the form. There is no need to rewrite it.
Choose to use full sentences or bullet points.
- You can decide to use a paragraph or bullet points. Examples are below.
Examples of what you might include:
- Academic challenges (like reading comprehension)
- Behaviors (like trouble staying on task or regulating emotions)
- Social interactions
- Communication issues
- Anything else that suggests a need for more tests.
Examples

Option 1: Paragraph

My child struggles with understanding longer reading assignments, and they often forget key details when answering questions. They also get frustrated easily in class and have a hard time calming down. Because of these concerns, I think they need more evaluations to see if they require extra support.

Option 2: List
- My child struggles with reading and forgets details.
- My child gets frustrated easily and has a hard time calming down.
I think more evaluations are needed because I have the following concerns: *
Types of Assessments or Evaluations You Are Requesting (not a full list / select all that apply):*

AutismExecutive FunctioningFunctional Behavioral AssessmentHearingMathOccupational TherapyPhysical TherapyReadingSensory ProcessingSpeech and LanguageVisionWritingOther
Select three (3) dates and times that you are available to sign the consent forms.

Date: Add the date.

Time: The format for the time is HH:MM. Example: 01:00 or 11:30

AM or PM: Make sure to select AM or PM.
1. Date*

MonthDayYear
1.Time*

Hour Minutes

AM/PM Option
2. Date*

MonthDayYear
2.Time*

Hour Minutes

AM/PM Option
3. Date*

MonthDayYear
3.Time*

Hour Minutes

AM/PM Option
Your Full Name*

First NameLast Name
Your Email*
example@example.com
Your Full Address

Street Address

Street Address Line 2

CityState

Zip Code
Your Phone Number*
Please enter a valid phone number.
Should be Empty: