Special Education Services – Request for Evaluation

STOP! The child is too old to receive Preschool-age special education services. Please contact Elementary Special Education at 385-646-4650. (Do not submit this form.)

Briefly describe your main concern with this child:*

Did you have a transition meeting?

Parent and Child's Street Address*

Parent and Child's City*

Parent and Child's Zip Code*

Which elementary school boundaries does the child live within?

If the child does not live within Granite School District boundaries, please contact your local school district.

Parent's Primary Phone Number*

Parent's Secondary Phone Number

What language does the child speak most often? (If they do not yet speak, what language is most often spoken at home?)*

What language did the child learn first? (If they do not yet speak, what language is most often spoken at home?)

What is the language most often spoken in the home?*

Special Education Services – Request for Evaluation

Special Education Intake Form

Your Information

Child's Information

Parent Information