FORM 21B NOTICE OF RECEIPT OF REFERRAL FOR SPECIAL EDUCATION ASSESSMENT This form serves as a notice to parent or guardian that their child has been referred for assessment. It is in a letter format and should be put on district letterhead.

 

    Enter date referral received

 

    Enter childs name

 

    Enter the name of the people who will be attending the IEP meeting.

 

    Enter name of contact person and phone number.

 

[Excerpted from the State SELPA IEP Manual, July, 2013]