Student Reevaluation Letter

STUDENT REEVALUATION REQUEST AND CONSENT

Student Name:    Date of Birth:

Student ID:    Grade/Program:

School:    Date of Request:

REQUEST FOR REEVALUATION

I hereby request a reevaluation of the educational needs and eligibility status of the above-named student. This request is made for the purposes of determining continued eligibility for special education and related services, reassessing present levels of performance, and identifying any additional supports or services required.

Reason(s) for requesting reevaluation (check all that apply):

Significant decline in academic performance New or changed medical condition New or increased behavioral concerns

Transition or graduation planning Parent/guardian request Teacher or staff request

Review of eligibility classification Other (describe):

ASSESSMENTS REQUESTED

Please indicate assessments you authorize or request as part of the reevaluation:

Educational achievement Psychological/cognitive Speech-language

Occupational therapy Physical therapy Functional Behavior Assessment

Hearing/vision screening Social/emotional screening Assistive technology evaluation

Other assessments requested (specify):

BACKGROUND INFORMATION

PARENT/GUARDIAN RIGHTS AND ACKNOWLEDGMENTS

By signing this document, I authorize the district to conduct the reevaluation assessments indicated above. I understand that the results of these assessments will be used to determine continued eligibility and to inform educational programming and services. I understand that information obtained through the reevaluation will be treated as educational records and will be released only to staff and professionals who have a legitimate educational interest, except as otherwise authorized by law.

I understand that I may request an independent educational evaluation at my own expense and that I may provide additional information, reports, or evaluations for the team to consider during the reevaluation. I further understand that I may revoke this consent in writing at any time prior to the initiation of assessments, and that revocation will not affect assessments already completed.

The district will make a good faith effort to complete the reevaluation and convene an eligibility determination meeting within a reasonable timeframe after receiving this request and any necessary consents, ordinarily within 60 calendar days. If an extension is necessary, reasons for the delay will be documented and provided to the parent or adult student.

DECISION

Indicate your decision regarding this request:

I request that the district proceed with the reevaluation as described above.

I decline reevaluation at this time. I understand that by declining I may request reevaluation in the future and that existing services and supports will remain in place unless modified through other procedures.

ADDITIONAL INFORMATION

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