Sample letter of referral for first time requests (for preschoolers)

Replace blue, bolded type with your information


Committee on Preschool Special Education Office (CPSE)
District Number


Re: Child's name and date of birth

Dear Chairperson,
I am referring my child, name, for a full evaluation because I believe that my child may require special education programs or services. I would like my child to receive the following evaluations: psychological, psychoeducational, occupational therapy, physical therapy, speech and language pathology (include all evaluation requests, delete those not requested).

I look forward to hearing from you.


Your name
Your address
Your telephone number



Keep a copy of the letter for your records.

If you haven’t heard from the district or received the consent form to evaluate within 10-14 days, contact CPSE to follow up.

Contact information for the CPSE Offices can be found on the NYCDOE website. If you do not know your district, type your address here to find out.

Evaluations must be free of charge.

Evaluations must be conducted in all areas of suspected disability and in the child's native language.

It may be helpful to attach a doctor’s note requesting specific evaluations. For more information about the referral and evaluation process, read our Special Education Timeline tip sheet.

Learning and School, Preschool and younger
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