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 child’s 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]