Simply replace the unfilled areas such as "" and "[date]" with your information.
Dear [School Official],
I would like to ask you to evaluate my child, [Child's Name] for the Special Education program. [He/She] is currently enrolled in the [Grade level] at [School].
It has come to my attention that [he/she] is not succeeding in school and I believe [he/she] may require special attention. For example, [cite specific concern]. Also, [cite additional concern]. We have tried to [action take to correct problem], but have had no success.
I would like to speak with you about the evaluation process. There are several questions that I need answered before we begin. So that we might discuss this matter further, I will call you this week to set up a meeting.