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Sample Letter Requesting Eligibility Services for Child with AD/HD

Name
Address
City, State
Phone

Date

Principal
School
Address
City, State

Reference: Jennifer Parent (DOB: 01/01/91)

Dear Principal: ____________________

I am the parent of ___________________, whose date of birth is ___________________ and who is a student in the ____________ grade at school. ___________________ was recently diagnosed with attention-deficit/hyperactivity disorder. Since ___________________ entered school, teachers have been raising concerns about (his)(her) academic performance and behavior. My child is not doing well in school and may need special education services. I am therefore requesting a multidisciplinary team evaluation to determine if ___________________ is eligible for special education and/or related services under both the IDEA (including the IDEA ?Other Health Impairment? category) and Section 504, in accordance with the IDEA regulations 34 CFR 300.7, plus the public education regulations of this state.

I look forward to hearing from you and to working with you and your staff to ensure a successful educational experience for ___________________.

Sincerely,

Name
Address
Phone