SAMPLE LETTERS & REQUEST FORMS

Sample Letter Requesting an Evaluation

Sample Letter Requesting an Independent Evaluation

New Jersey Department of Education Request for Mediation / Due Process / Emergency Relief Hearing

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APPENDIX F

SAMPLE LETTERS & REQUEST FORMS

 


SAMPLE LETTER REQUESTING AN EVALUATION

[Your Address]
[Your Phone Number]
[Today's Date]

[Principal's Name]
[School Name]
[School Address]

Dear ____________:

      I am the parent of ____________________, age _____, who is currently a student in grade _____________ at _____________ School.  I have reason to believe that my child has special needs that require special education and related services.  [Briefly explain why you believe this to be true.]  Please arrange to have my child evaluated by a child study team as quickly as possible, so that an appropriate program for (him/her) can be provided. Thank you.

Yours truly,

[Your Name]

This sample is provided for the purpose of serving as a guide to you in composing your own letter and was originally developed by the Education Law Center in Newark, NJ.

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SAMPLE LETTER REQUESTING AN INDEPENDENT EVALUATION

[Your Address]
[Your Phone Number]
[Today's Date]

[Director of Special Services]
[Board of Education]
[Address]
[City, State, Zip]

Dear _______________:

I am the parent of ______________, age _____.  I am currently in disagreement with the present evaluation completed by __________________ [member of the Child Study Team or by the entire Child Study Team].  [Briefly explain the areas you are in disagreement with]  I am requesting an independent evaluation, to be provided at public expense.

Please provide me with the names of approved agencies/clinics located within our county that can provide the evaluations requested.  Please also inform me of the voucher system or method of payment in writing. Thank you.

Yours truly,

[Your Name]

This sample is provided for the purpose of serving as a guide to you in composing your own letter.

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New Jersey Department of Education Request for Mediation / Due Process / Emergency Relief Hearing

Page One

Date:       _________________________

To:       Barbara Gantwerk, Director
           
NJ Department of Education
           
Office of Special Education Programs
           
P.O. Box 500
           
Trenton, NJ 08625-0500

From:   (Name of parent or school district submitting the request)
Address:     
Phone:    ( ____ ) ______ - _________     
Fax:    ( _____ ) ______ - ________

____  Attorney          ____  Advocate
Name: (Name of attorney or advocate)
Address:
Phone:    ( ____ ) ______ - _________     
Fax:    ( _____ ) ______ - ________

Requesting:     
____  Mediation

____  Due Process Hearing
____  Emergency Relief Hearing (Attach affidavit or notarized statement)

On behalf of:   (Child's name)
Child's Address: 
District of Residence:   
School the student attends:   

NJ DOE Request for Mediation/Due Process/Emergency Relief Hearing

Page 2

Please describe the nature of the problem with the school and any facts relating to the problem (attach additional pages if necessary):

 

 

Please describe how this problem could be resolved (attach additional pages if necessary):

 

 

Signature of party submitting request:

____  Please check to verify that a copy of this request was sent to other party

Name of other party:   
Address:    

Note to parent(s) requesting a Due Process Hearing:  The IDEA Amendments of 1997 require parent(s) or their attorneys to provide the information contained within this form to the NJ Department of Education and the district of residence.  Failure to provide this information may result in a reduction in the award of attorneys' fees.  (20 U.S.C. 1415 (b)(7), (i)(3)(F).

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