Committee on Special Education – Referral Letter

Current Date


Dear ___________________________ (chairperson of CSE)

_______________________________ School District

_______________________________ Address


I would like my child _______________ (insert child’s name) to the Committee on Special Education.  My child’s birth date is _____________ (insert birth date).  I am concerned that my child __________________________________________________________________ (insert reasoning for wanting special education).

I understand that someone from CSE will be contacting me to explain the Program.  The best time to reach me is on __________ (insert date) and _____________ (time of day).



___________________ Parent(s) Name
___________________ Parent Address
___________________ Parent Contact Phone number
___________________ Parent Contact email

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