Notification of Proposal for Initial Special Education Evaluation

District/LEA: Enter your district/LEA name.
Student Name: Enter the name of the student	Date of Birth: Enter the student’s DOB.

Dear Parent of Enter student name., Date: Enter a date.

Your child was referred by ☐ Parent ☐ Babies Can’t Wait (BCW) ☐ Student Support Team (SST) ☐ Other: ___________________ and was recommended for evaluation to determine if your child is eligible for special education services and supports.

The school system is proposing to conduct an individual evaluation to gather more information about how to better meet your child’s needs and determine whether your child is eligible for special education services.

The district is proposing to conduct an individual evaluation for the following reasons:

Describe why the district is agreeing to pursue the evaluation.

Describe the evaluation procedure(s), assessment(s), record(s), or report(s) the district/LEA used in the decision.

Describe the evaluation procedure(s), assessment(s), record(s), or report(s) the district/LEA used in the decision.

Describe any other options considered and the reasons those options were rejected.

Describe any other options considered and the reasons those options were rejected.

Describe any other factors relevant to the decision.

Describe any other factors relevant to the decision.

Enter Contact Name	Enter position	Enter phone number	Enter the email
Name	Position	Phone Number	Email