Parent Referral Forms


This form will help parents, district staff, public agencies, or other people with information about a student to request a special education evaluation (also called a “special education referral”). This form is not required – any written request for evaluation is valid. Districts may follow up a verbal, email, or other written request with a request to complete this form, but may not require the referrer to complete the form prior to considering the student for evaluation. It is important to note that the 25-day timeline described below starts as soon as the request is received, whether or not this form is used.


Once the district receives a written request for evaluation in any form/format, they have 25 school days to review information about the student, including school and medical records and information from parents, and decide whether to evaluate the student for special education eligibility. If the district decides to evaluate, it must obtain written and informed consent from the parent prior to beginning the initial evaluation. See below for a timeline flow chart.

Timelines for Referral, Initial Evaluation, and Initial Individualized Education Program (IEP)

Referral Form Flowchart