Protections for students who may require special education. D I give consent for my child to be evaluated.Here is a sample letter requesting an evaluation: Date. I am requesting an IEP meeting regarding the program for my student, NAME, (BD: 00000000). I am writing to request an Independent Educational Evaluation at public expense, for the following reasons: (BRIEFLY list your reason(s). As a sample, the letter has some madeup information about a fictional student and their technology needs. How do I make a referral for an evaluation? My child has not been doing well in school and I believe. May need special education services. Child Care Licensing Letter Templates.