- Keep a copy for yourself.
- Hand deliver and ask for a date stamp or send with Return Receipt to establish timeline or email as an attachment.
(City, State, Zip Code)
(Daytime Telephone Number / Email)
(Title – i.e. Director of Student Services / District 504 Coordinator)
(District Office or School Address)
(City, State, Zip)
Regarding: PWN Request
Student Name: ( )
Date of Birth: ( )
Name of School: ( )
Grade: ( )
At our meeting (or) during our conversation on (Date), we discussed my child’s (For example evaluation, eligibility, placement, IEP, services, etc.). I requested (insert what you requested) but the IEP team denied the request (or) the school has decided to (insert decision). I am requesting for Prior Written Notice (PWN) in line with the IDEA regulations regarding this decision.
According to the IDEA, at 34 CRF §300.503, prior written notice must include:
- A description of what the school is proposing or refusing to do;
- An explanation of why the school proposes or refuses this action;
- A description of any other options the school considered and the reasons why those options were rejected;
- A description of each evaluation procedure, test, record, or report the school used as a basis for this decision;
- A description of any other relevant factors that went into this decision;
- Information on how I can obtain a copy of procedural safeguards and an explanation available to me, and
- Information on sources I can contact for help in understanding IDEA’s regulations.
Please send me a copy of the PWN on this decision. Thank you for your attention to this matter.
cc: (your child’s teacher) and (other staff if applicable)
- Sample Letter – Section 504 Determination Request
- Sample Letter – Request to an Evaluation for an IEP & 504 Plan
- Sample Letter – Request for Prior Written Notice – PWN
- Sample Letters – Notification of Illness from School Nurse