[Your Address]
[Your Phone Number]

Name of Special Education Director (or Superintendent)
School District Name
School District Address

Dear :

My/our child [name of child], is a resident of [name of district]. Currently, [name of child] attends [school, class, program, etc.]. [Name of child] has [brief description of disability] and qualifies for special education services under the Individuals with Disabilities Education Act (IDEA).

[Describe the problem. If there are several, list and number them separately. Include facts and dates if you have them.]

[Describe the steps you have taken to resolve the problem(s): who you talked to, when, what happened, etc. This might include meetings you have had, letters you have written, agreements you thought were made, etc.]

[Make specific requests for solving the problem(s) and include any information that supports your position.]

I/we understand that under the IDEA, I/we have the right to prior written notice anytime the school district proposes or refuses to initiate or change the identification, evaluation or educational placement, or the provision of a free and appropriate education to my/our child. Please provide me/us with a written response to my/our request by [list date by when you want a response; usually 10 working days is more than reasonable.]

Thank you.

Sincerely,

Your name(s)

cc: Student's Permanent School File