Request for Personalized Education Plan

Date: ____/____/____

Your name: _______________________

Your full mailing address: _______________________

_______________________

_______________________

Name of the Principal: _______________________

School’s mailing address: _______________________

_______________________

_______________________

Dear Principal _______________:

I am writing to request that the school develop a Personalized Education Plan for my child, ______________________. His/her date of birth is ______________________.

I am concerned about [his/her] educational progress because [he/she]

____ failed end-of-year test last year

or

____ is struggling in classes this year

Because I believe my child is at risk of academic failure, I am requesting that the school conduct a diagnostic evaluation and develop focused educational interventions, as required by N.C. General Statute § 115C-105.41.

Please contact me within ten business days to schedule a time to meet with the team that will be conducting the diagnostic evaluation and for me to sign any necessary paperwork so that my child’s needs can be addressed as soon as possible.

I look forward to hearing from you soon. My daytime telephone number is ________________. Thank you for your time.

Sincerely,

_______________________