Education Law Advocates, P.C.

Sample Letters and Forms

Education Law Advocates, P.C.
Education Attorneys

I.  SAMPLE LETTERS FROM PARENT TO THE SCHOOL

Letter from Parent to School Requesting Child's Educational Records *

Letter from Parent to School requesting an evaluation for special education eligibility and services

Legal Notice ("Gebser Letter") from Parent to School in Title IX Cases

II.  INTAKE FORMS - EdLaw CLIENTS

Special Education Case Client Information Form (Due Process Cases)

Initial Client Interview - Important Questions

III. IEP FORMS

Annotated Individualized Education Program "IEP" Form for School Age Students

Annotated Notice of Recommended Educational Placement Form

IV. EVALUATION FORMS

Annotated "Permission to Evaluate" - Consent Form (School Age)

Annotated Reevaluation Report - (School Age)

Annotated Evaluation Report

V.  MEDIATION AND DUE PROCESS FORMS

Mediation Request Form (Important: See Further Instructions at Office of Dispute Resolution Website)

Due Process Complaint Notice (Important: See Further Instructions at Office of Dispute Resolution Website)

VI.  OTHER

Procedural Safeguards Notice

Bureau of Special Education Complaint Form and Information Packet (See Further Instructions at ODR Website)

Letter from Parent to School Requesting Child's Educational Records*

Note:  Single space the inside addresses and the "Re" lines, instead of double-spacing as shown (website editing function wouldn't permit us to show addresses single spaced).

John and Mary Parent

[Street Address]

[State, Town and Zip Code]

[Phone number]

[Email address]

[NAME OF PRINCIPAL]

[NAME OF SCHOOL]

[STREET ADDRESS]

[TOWN, CITY, ZIP CODE]

RE:   Request and Parental Consent for Student's Education Records

Child's Name

DOB: (fill in birthdate)

School Name and Grade: (fill in status)

Dear Mr., Ms., Dr. _____________:

I request a copy of all education records in the School District's possession that pertain to [name of student].  I make this request under the Family Educational Records and Privacy Act (FERPA), 34 C.F.R. Part 99, the Individuals with Disabilities Education Improvement Act (IDEA 2004), and its regulations, 34 C.F.R. Sections 300.501 and 300.610-627.

This request encompasses the identified education records no matter where they may be located, whether in the Central Administration Office, the Special Education Office, or any other department or office within the School District.  As authorized by Section 300.616 of the IDEA 2004 regulations, kindly also provide me with a "list of the types and locations of the [requested] education records" that are "collected, maintained or used" by the School District.

This request includes any and all items that contain personally identifiable information about [first name of student] and[names of parents], whether those items name us as the parents, name our child, or refer to our child or us, as the parents, by social security number or by student identifier number.

This request includes, but is not limited to, the following items: progress reports, report cards, deficiency notices, correspondence to and from parents and others, awards, standardized test results, staff memos, interoffice memos, emails, letters, notes and comments of any kind, including notes of telephone calls, multi-disciplinary meetings and observations of child, attendance records, including notices of truancy, suspension and expulsion, requests for and notices of Section 504 and IEP meetings, medical and school health records, notes of psychologists, speech and language therapists, resource specialists and other personnel who have provided services to, evaluated or otherwise been involved in or responsible for the provision of a free appropriate education, class schedules, referrals for evaluations, evaluations and assessments, third-party reports or writings of any kind, notices of placement and statements of rights that were provided to parents, including notes from multi-disciplinary team meetings and observations of the child, all IEPs and any documents related to the IEPs, videos and audiotapes.

I will contact you by phone by [a date two days after letter will be received] to find out when the records will be ready for pick-up.  Please contact me if you have any questions.

Thank you.

Sincerely,

Mr. or Mrs. Parent

cc:  [Director of Special Education]

*Form for students age 17 and younger; certain restrictions apply under FERPA for students 18 and over.  Contact our office if you would like more information.

Letter from Parent to School requesting an evaluation for special education eligibility and services

Note: Single space the inside addresses and the "Re" lines, instead of double-spacing as shown (website editing function wouldn't permit us to show addresses single spaced).

John and Mary Parent

[Street Address]

[State, Town and Zip Code]

[Phone number]

[Email address]

[NAME OF PRINCIPAL]

[NAME OF SCHOOL]

[STREET ADDRESS]

[TOWN, CITY, ZIP CODE]

RE: Request and Parental Consent for a Special Education Evaluation

Child's Name

DOB: (fill in birthdate)

School Name and Grade: (fill in status)

Dear Mr., Ms., Dr. _____________:

I request the school district to evaluate my child, [name of child], for special education eligibility and services.

I am concerned about my child's progress in school.  [Briefly describe the problems that your child is experiencing.  You can mention your own observations, such as "When I work with Lisa or her homework at night, I notice that she does not seem to be able to sound out the words."  Or "my son seems to be very unhappy in school and tells me that he can't keep up in the math class."  Or "Mrs. Smith, Mary's language arts teacher, tells me my daughter is falling behind in her classwork and has trouble paying attention in class."]

I understand that the evaluation will be performed in the manner required by the Individuals with Disabilities Education Act (2004) and the related federal regulations, beginning with the parental consent section at 34 C.F.R. 300.300.

Kindly provide me with a Permission to Evaluate form promptly, as required by 22 Pa. Code Section 14.123(c). I understand that the law requires the school district to complete the evaluation and provide the parents with a copy of the evaluation report within sixty (60) days of the date we return the signed Permission to Evaluate form to the school district.  I am eager to complete the Permission to Evaluate form so that the evaluation process can begin.

I will call you by [a date two days after letter will be received] to follow up on this request. If you have any questions about this request, you may call or email me.

Thank you.

Sincerely yours,

Parent

cc: [Director of Special Education]

Sample "Gebser Letter" for Bullying and Sexual Harassment Cases subject to Title IX

Note :  (1) This is a sample "Gebser letter." In cases of serious bullying or sexual harassment, we encourage parents to consult a qualified attorney because the law in this area is complicated and every case is different. If you nevertheless will be using this letter as a reference in preparing a "Gebser letter" to your school district, we strongly encourage you to first read our article on Gebser letters in the November 2010 issue of our newsletter posted here. This sample letter is for educational purposes only and does not constitute legal advice. We make no representation that it satisfies the legal requirements for effective notice under Title IX that may apply to the facts in your particular case; (2) This sample letter includes hyperlinks to case law. We therefore favor transmitting it both by certified mail, return receipt requested, and by email that includes the links; (3) Fonts should be consistent in your letter; ignore font differences in this sample letter.

John and Mary Parent
Street Address
State, Town and Zip Code
Phone Number
Email Address

Certified Mail, Return Receipt Requested

[Name of Principal] [Note:  Use single vertical spacing in inside address, in the "RE" lines, and the "cc" lines, unlike the double vertical spacing shown here; cannot display it correctly here]

[Name of School]

[Street Address]

[City, State Zip Code]

RE:     Legal Notice of Title IX Violation

Child's Name

D.O.B: _____________

Name of School, Grade ____

Dear Mr., Ms., Dr. ______________:

This follows our previous meeting(s) on _______________, my previous letters of ______________, and our previous phone conversations on ________________ [give dates if you can] in which I have repeatedly sought the school district's help to stop the bullying [harassment, sexual harassment] 1 [see endnote 1 below - don't include endnotes in your letter] of my child [name] , age ____. Despite these efforts, the school has failed to take effective action, the bullying is continuing, and the bullying is harming my child.

Background2

I previously have described in detail the bullying that began on _______ [give the date or approximate time when the bullying began, if you know it]. Since the last incident of [date} that I reported to you, I have learned that the bullying is continuing. [Describe in detail each incident of bullying that has occurred since that time, giving dates and times, locations, the words used by the offender(s), if any, during the incident, how you learned of it, and any other important details. Stick to the facts as you understand them. Be specific and accurate. For example, if the offenders cursed at your child or called your child names, state specifically what they said, if you know, and how you know - ex., "My son reported to me that one of the boys 3 who attacked him called him a "sissy" and a "fag." If the offenders pushed your child, state who did it and how they did it. Ex: "My daughter reported to me that a girl approached her from behind, grabbed her around the neck, and jerked her backwards causing her to lose her balance and fall backward to the floor."  Naturally, if your child was injured in a bullying incident, you should obtain necessary medical attention. You also could consider attaching a letter from your child's pediatrician or other physician documenting the medical evaluation and treatment, or other proof of the treatment. If your child sustained a visible bruise or other injury in a bullying incident, you should take photos showing the injury. You also could consider attaching the photos to your letter to the school. Remember: A primary goal here is to get the school to take the bullying seriously and take effective action to end it]. 4

The Continuing Bullying is Harming my Child

The continuing bullying is having very harmful effects on my child. [Describe how your child is being affected by the continuing bullying, any adverse changes you have observed in your child, comments by your child showing the effect on him or her, comments by outside tutors, psychologists, or others about effects of the bullying or adverse changes they have observed since the bullying began. Exs: expressions of fear or reluctance to attend class or school, loss of interest in homework or school, decline in grades, attempts to remain at home during school hours, increasing absenteeism, decline in self-esteem, increasing unhappiness or moodiness, etc. If your child is seeing an outside therapist or other counselor, consider requesting a letter from them that you can attach to your letter or that they can send separately to the school official documenting the harmful changes they have observed in your child as a result of the bullying].

Formal Notice to the School District under Title IX of the Education Amendments of 1972

As you know, I have sought to work with you and others at the school in a cooperative way to help resolve this problem informally. I repeatedly have written to you, met with you, and discussed this matter on the phone with you and others at the school district. I repeatedly have requested you to take effective action to stop the bullying. I have proposed solutions to the problem to the best of my ability. The solutions I have proposed include [ summarize them ]. To date, the school district has failed to take effective action to stop the bullying, the bullying continues, and the bullying continues to harm my child.

I regret that the situation has reached a point where it is necessary for me to send you this formal notice of potential legal action. This notice is intended to conform to the requirements of Title IX of the Education Amendments of 1972, as interpreted by the U.S. Supreme Court in Gebser v. Lago Vista School District, and subsequent case law.

It is my understanding that the [name of school district] meets the legal requirements in this case to be held liable to my child and me, as the parent, in a federal lawsuit seeking money damages for violating Title IX. The school district operates an educational program that receives federal funds and therefore is subject to Title IX. The bullying of my child at school is "severe, pervasive, and objectively offensive," as documented in this letter and in my prior communications with the school. You, as the principal, and the other school district officials who are receiving copies of this letter, have the power and authority over the offenders, the other students, school personnel, and the circumstances involved here to effectively investigate and take action to stop the bullying of my child. You and the other school officials unreasonably have failed to date to take effective action to stop the bullying. In fact, the district has effectively refused to take the necessary action, which shows a deliberate indifference to the bullying of my child and to the district's legal responsibility to intervene to stop the bullying. The continuing bullying of my child is causing severe harm to my child and is preventing my child from having the same access to the benefits of the education that the school district provides to other students in the program. The district therefore is unfairly and illegally discriminating against my child.

Although this letter is specifically intended to provide the required formal notice to the district under Title IX, it is my understanding that my child and I may have additional legal rights under other federal and state laws against the district arising from its failure to take effective action to end the bullying that continues to harm my child. Accordingly, please be advised that, if necessary, we will pursue a legal action against the district to the fullest extent possible.

My primary goal at this point, however, is for the school district to take effective action to end the bullying that is harming my child.  I believe this demand is consistent with the directive to school districts issued in a "Dear Colleague letter" on October 26, 2010 by the Office of Civil Rights, which emphasizes that a "school district may violate [federal civil rights laws] when peer harassment based on race, color, national origin, sex, or disability is sufficiently serious that it creates a hostile environment and such harassment is encouraged, tolerated, not adequately addressed, or ignored by school employees."  (Letter, p.1, 10/26/10, Russlyn Ali, Assistant Secretary for Civil Rights, Office of Civil Rights, U.S. Department of Education).  I believe the bullying of my child has created a hostile environment at school, and that the school district has failed to take effective action to correct it.

Request for Meeting

Please know that I sincerely want to continue working with the school district to stop the bullying of my child. I therefore request a meeting with you, Superintendent of Schools [ name ], and Special Education Director [ name ], [if your child is a special education student]. [If there are others you think should attend the meeting, such as the IEP team, identify them]. I am available for that meeting at the following dates and times. [Give at least three alternative dates and times]. I will call you by [specify a date within two days of the date your letter will be received - and then call to follow up at that time].

Sincerely yours,

Mary Parent (better, if possible, for both parents to sign and to change the text of the letter to reflect that it is from both parents)

cc:   Dr., Ms., Mr. [Name of superintendent of schools]

Dr., Ms., Mr. [Name of special ed director, if your child is a special ed student]

Any other key players at school you think should receive notice

Note : We recommend that you send the letter by certified mail, return receipt requested, to ensure proof of receipt and to underscore the "legal" and important nature of this notice. Also transmit copies by email so that the recipients can click on the links in the letter, if they choose.


1 A Gebser letter like this sample letter has specific reference to Title IX of the Education Amendments of 1972. Title IX protects students at schools receiving federal funds, like public schools, from bullying or harassment based on sex or gender. It also encompasses sexual harassment, such as when peers (or a teacher) attempt to, or do, coerce a student into a sexual relationship or sexual conduct. For more information, see our newsletter article on Gebser letters here or, better yet, consult a qualified attorney in all serious cases of bullying or sexual harassment at school. We generally will use the shorthand term, "bullying," in this sample letter to refer to the conduct in question, but if sexual harassment is involved, you should use that term as well. Be aware also that parents and students may be protected from bullying or sexual harassment by other federal and state laws.

2 Consider using headings, especially in a longer letter.

3 Although you likely will be required to "name names" of the offenders in your contacts with the school concerning the bullying, do so only with extreme care, being very careful to state the facts as you understand them, and provide the names only under appropriate circumstances. Request the party to whom you are required to give the names to keep them confidential and confirm in writing that you have made that request. We do not favor identifying offenders by name in this letter because it is not necessary to provide effective notice under Title IX and may unnecessarily expose you to a lawsuit for defamation, if you make false statements about another person that causes them injury. Keep in mind that you can be sued by an offender or the offenders' parents for defamation regardless of whether the claim has merit and regardless of whether you describe only the offender's conduct, but do not provide the offender's name. That is a risk you must balance against the risk of failing to take the necessary action to end the bullying.

4 If you can document facts showing that the bullying is based on sex or gender, you should do it because Title IX covers only sex and gender-based bullying and harassment. (See our article on "Gebser letters" in our newsletter). In some cases, it can require close scrutiny and a thorough understanding of the law to determine whether a particular form of conduct may trigger a student and parent's legal rights under Title IX. For this and other reasons, we strongly encourage parents to consult a qualified attorney in serious cases of bullying or sexual harassment.

II.  CLIENT INTAKE FORMS

Special Education Case Client Questionnaire (Due Process Cases)

Your name:

Address:

Phone numbers:

Home:                         Work:                          Cell:                            Email address:

Child's name:

School name:

School address:

Principal's name:

Special education director's name:

Child's grade level:

Child’s weakest academic areas:

Child's strongest academic areas:

What do you think your child's level is in reading? Writing? Math

When did the school develop your child's first IEP or 504 plan?

What are the dates of all your child's IEPs or 504 plans?

What are your child's disabilities, according to the school?

What are your child's disabilities, according to you?

Have you ever filed a complaint with the Pennsylvania Department of Education or ever made a previous due process request? If so, give dates.

How many times have you or someone on your behalf visited your child's classroom during the last six months?

If you could wave a magic wand and whatever you wanted for your child's schooling would come true, without regard to money, time or the school district's opinion, what would you want for your child?

IDENTIFICATION AND EVALUATION

1. In your opinion, was the school slow to acknowledge your child's special needs? If so, when did you first point out the problems to the school and ask for an evaluation? And when did that evaluation occur?

2. When were the evaluations of your child done? Has the school reevaluated your child every three years, at least? When did the school share those results with you?

3. Did you pay for the evaluations of your child? Or did the school pay for the evaluations'?

4.. Did the school make available to you a copy of the evaluation report no later than five days prior to the date of the scheduled 504 meeting or case conference committee (CCC) meeting?

5. Did you ever request an independent educational evaluation? What was the school's response? When did you receive the school's response?

OTHER SERVICES

6. Did the school ever offer Extended School Year (ESY) services to your child? If so, do you believe that those services were adequate? Did you see regression in your child during the summers, whether ESY was offered or not?

7. How about occupational therapy, speech therapy, physical therapy?

DISCIPLINE

8. Was your child ever suspended or expelled? Did the school continue to provide education and services to your child during that period of suspension or expulsion?

9. Has your child been disciplined for behaviors that are tied to his/her disabilities? If so, describe the discipline administered and the alleged reason for it. Continue on back if necessary.

10. If your child has had behavioral problems, was a Functional Behavior Assessment (FBA) done? If so, was a Behavior Intervention Plan (BIP) implemented?

11. If your child has been suspended, did the school provide, subsequent to the suspension of your child, a written statement to the parent regarding the student's misconduct and action taken?

12. If your child was suspended or expelled, did the school conduct a manifestation determination hearing within 10 instructional days of deciding to change the student's placement for disciplinary reasons? Did the school inform the parent of the decision and inform the parent of his/her rights?

PROCEDURAL VIOLATIONS

13. At the IEP meetings or 504 meetings, have the following people been in attendance: one or more of the student's current teachers or, for a new student, a teacher licensed in the area of the suspected disability; and at least one member of the multidisciplinary evaluation team or some other person knowledgeable about the evaluation procedures used and familiar with the evaluation results if the student was evaluated for the first time?

14. When the school set the date and time of an IEP or 504 meeting, were you consulted about the setting of that date and time or were you told to show up or else?

15. Did the school offer any training to you as a parent on the areas of your child's disability? Or were you training the school on those?

16. Did the school conduct staff and teacher training in the areas of your child's disability?

17. Did your school provide you with a copy of the notice of procedural safeguards at the time of notification of a CCC meeting or 504 meeting?

18. Did your school share records about your child with outsiders without your written permission?

19. Have you ever requested an IEP meeting or a 504 conference and had your request ignored? When?

20. After a case conference committee meeting or 504 meeting, were you presented with an IEP or 504 plan within 10 business days?

21. Did you ever ask for a copy of the school's file pertaining to your child? If so, did you receive the file? Was it complete, to the best of your knowledge? How long after your request did you receive the file?

22. Did the school share all academic and disciplinary records with you as they were produced? Or did you find some new records that you had never seen before at the time you received a copy of the school's file pertaining to your child?

23. Did the school change the placement of your child (new school, new environment) without convening the case conference committee or a 504 meeting?

FAILURE TO FOLLOW IEP/504 Plan or DEVISE PROPER IEP/504 Plan

24. If your child was to be provided accommodations for testing, which were listed in his IEP or 504 plan, were those accommodations given to your child?

25. Did the school follow all provisions of the child's IEP or 504 plan? If not, what provisions did the school not follow?

26. Were the goals and objectives written in any IEPs actually measurable?

27. Were the methods that were supposed to be used to measure them actually used?

28. Were the methods that were supposed to be used to inform you about your child's progress actually used?

29. Were all your child's teachers, even substitute teachers, familiar with your child's IEP or 504 plan?

30. Did your school ever have an IEP in place that was more than one year old?

31. Were you presented with a copy of the draft IEP before the IEP meeting or was your first viewing of it at the meeting itself?

DENIAL OF FAPE

32. Was your child's school day shorter than other kids' school day?

33. Were the recommendations of your health care professionals or experts ignored when presented at the IEP meeting?

34. Was your child allowed to participate in extracurricular activities that were offered to their non-disabled peers?

35. If you have provided transportation to school for your child, has the school offered to reimburse you for the costs and mileage?

36. Do you believe the school failed to provided needed education and services to your child because of staffing problems or budgetary issues, rather than your child's needs?

37. Do you believe that your child should have been provided assistive technology (computers, electronic devices) but was not? If so, what kind of assistive technology would have benefited your child and why?

38. Did the school bar your expert or advocate from attending and participating in the IEP meeting?

39. Do you believe the school failed to allow you and your experts/advisers to participate meaningfully in the decisions made as to your child's education?

40. Was your child educated in the Least Restrictive Environment (LRE), meaning was the classroom, resource room, etc., the best learning environment for your child, based on your child's needs?

41. If we go to a due process hearing, do you want the hearing to be open (as in open to the public so that other school officials and your family and friends can attend) or do you want it to be closed (as in closed to anyone who's not a party and who is not testifying as a witness?

FOR OLDER STUDENTS ONLY

42. For older students, did the school provide a free appropriate public education to your child who is less than 22 years of age and has not received a regular high school diploma?

43. For older students, did the school provide written notice at an IEP meeting no later than the student's 17th birthday, that the rights currently afforded the parent will transfer to the student at the age of 18 unless a guardianship of the student has been obtained?

44. If your child is age 16 or older, was he or she invited to the IEP meeting?

45. If your child is age 16 or older, was a transition plan included in his/her IEP?

HOMEBOUND INSTRUCTION

46. Was your child receiving homebound instruction? If so, did the IEP Team meet every 60 instructional days during that time period?

POTENTIAL WITNESSES

47.  Please list the name, address, phone number and what you would expect each witness to be able to address at a possible hearing in your case. Add more sheets if necessary.

Name:

Title or Role of person:

Address:

Phone number:

Testimony would concern:

48.  Is there anyone at the school district currently or in the past whom you believe shares your views of who your child is and what your child needs?

Name:

Title or Role of person:

Address:

Phone number:

Testimony would concern:

Name:

Title or Role of person:

Address:

Phone number:

Testimony would concern:

Initial Client Interview - 20 Important Questions

1. Did you receive a copy of your rights or procedural safeguards at any time? Have you read it?

2. Have you ever filed a complaint with the Pennsylvania Department of Education or contacted that department concerning your child's schooling?

3. Have you ever been to mediation or any other type of formal meeting with the school district?

4. If your child has been classified by the school system as having a disability, do you agree with that diagnosis? Why or why not?

5. Do you know and understand your child's IQ? Are you familiar with the "bell curve?" What is your expectation overall for your child? Do you anticipate your child will finish high school on a regular diploma track? Will he or she go to college?

6. What do you think your child's ability level is in reading? Writing? Math?

7. Is there anyone at the school district whom you believe shares your view of who your child is and what your child needs?

8. Does your child have an IEP in place now? If so, do you think the IEP in place is appropriate or not? If not, in what ways do you think itis deficient?

9. Have you organized and filed your child's school records in a binder?

10. If behavior is an issue:

a. What is the worst act of misbehavior your child has engaged in at school?

b. How frequent is your child's misbehavior?

c. Does your child misbehave at home?

d. Has your child ever hurt any individual by his or her misbehavior?

11. Have you visited your child's classroom or program during the last six months? If so, how many times? Has anyone other than yourself visited your child's classroom or program during the last six months?

12. Are you familiar with web resources for information on special education, the law, and your child's disability?

13. Were you satisfied with your child's program before this year?

14. Have you ever complained to anyone in the district administration, such as the superintendent or a school board member? If so, have you complained in writing?

15. Have you ever requested the school to provide a complete copy of your child's educational records?

16. Do you understand your child's current IEP?  If not, what don't you understand?

17. Has your child's IEP team ever discussed "ESY," a behavior plan, assistive technology, transition planning, or interagency programming?

18. Have you reviewed your child's comprehensive school evaluation?  Do you understand it?  If not, what don't you understand?

19. Are you familiar with an Independent Educational Evaluation ("IEE")? Have you ever requested the school district to pay for an IEE?

20. If you could wave a magic wand and whatever you wanted for your child's schooling would come true without regard to money, time or the school district's opinion, what would you want for your child?

For more information on Pennsylvania law and practice affecting children with disabilities, call us now at 610.606.5006 or email us now!

ELA Education Law Advocates PC - Special Education Lawyers

The Culbertson Building
590 Snyder Avenue
West Chester, Pennsylvania 19382
Voice: 610.696.5006
Fax: 610.696.6590
E-mail

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Education Law Advocates, P.C. skillfully represents parents and their special needs children in southeastern and central Pennsylvania, including West Chester, Lower Merion, Coatesville, Paoli, Downingtown and Upper Darby, and throughout the Philadelphia metro area, including Chester County, Montgomery County, Delaware County, Bucks County, Philadelphia, Lancaster County and Berks County.

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