[Lub Npe]
[Chaw Nyob]
[Lub Nroog], CA [Tus Zauv Xa Ntawv (Zip Code)]
[Tus Naj Npawb Xov Tooj]

[Hnub Tim]

[Tus Thawj Saib Xyuas/Tus Thawj Kws Qhia Ntawv Lub Npe]
Tus Thawj Saib Xyuas Kev Kawm Ntawv Tshwj Xeeb [LOS SIS Tus Thawj Kws Qhia Ntawv ntawm [Lub Tsev Kawm Ntawv]]
[Lub Npe Ntawm Lub Cheeb Tsam Tsev Kawm Ntawv]
[Chaw Nyob]
[Lub Nroog], CA [Tus Zauv Xa Ntawv (Zip Code)]

Qhov Xwm Txheej: [Tus Tub Ntxhais Kawm]

Nyob Zoo Txog Rau Tus Thawj Saib Xyuas/Tus Thawj Kws Qhia Ntawv [Lub Npe]:

Kuv yog [leej niam los yog leej txiv/tus neeg saib xyuas] ntawm [Tus Tub Ntxhais Kawm], uas muaj hnub nyoog [lub hnub nyoog] xyoo thiab nyuam qhuav sau npe rau hauv [Qib Kawm] ntawm [Lub Npe Tsev Kawm Ntawv]. Kuv sau ntawv txhawm rau muab [Tus Tub Ntxhais Kawm] cov kev tshuam xyuas los txiav txim siab tias nws/lawv puas tsim nyog tau txais cov kev pab cuam kev kawm ntawv tshwj xeeb thiab kev pab txhawb nqa. [Tus Tub Ntxhais Kawm] uas tsis muaj kev vam meej nyob hauv tsev kawm ntawv. 
Kuv xav kom Lub Cheeb Tsam Tsev Kawm Ntawv los ua kom tiav cov kev ntsuam xyuas suav nrog tab sis tsis txwv rau kev soj ntsuam xyuas kev puas siab ntsws txhawm rau kev ntsuas kuv tus menyuam txoj kev paub, kev xav ntawm lub hlwb, thiab kev kawm tiav rau fab kev ua hauj lwm. [Yog tias muaj tseeb, muaj xws li: Dua li nod lawm, kuv ntseeg tias kuv tus menyuam yuav muaj [lub npe ntawm tus neeg uas xoom xaim tias muaj kev tsis taus ntawm lub cev] thiab lub tsev kawm ntawv yuav tsum ua kom tiav cov kev tshuaj xyuas ntxiv no txhawm rau ntsuas cov kev tsis taus no.  
Kuv kuj tseem thov kom lub cheeb tsam tsev kawm ntawv ua qhov kev ntsuas kuv tus menyuam raws li cov lus hais tseg ntawm Tshooj 504 uas nyob hauv Tsab Caij Lij Choj Hais Txog Kev Rov Kho Kom Zoo Li Qub ntawm xyoo 1973 (Tshooj 504) raws li lub ncauj lus 34 C.F.R. Tshooj. 104.35, rau qho kev xav tau ib qhov kev pab cuam kev kawm ntawv tshwj xeeb twg uas yuav xav tau ib qho chaw so los sis kev hloov kho txog qhov kev pab uas tsis muaj nyob hauv qhov kev kawm ntawv tshwj xeeb los sis yog tias kuv tus menyuam tsis pom muaj feem tau txais kev kawm ntawv tshwj xeeb. Kuv kuj tseem thov kom tus Neeg Koom Tes Saib Xyuas Hauj Raws Li Hauv Tshooj 504 tuaj koom nrog lub rooj sib tham IEP thawj zaug txhawm rau sab laj txog cov kev soj ntsuam tau los thiab cov kev taw qhia ntawm qhov Kev Soj Ntsuam Xyuas Raws Li Tshooj 504. 
Kuv vam thiab cia siab tias yuav tau txais daim phiaj xwm kev ntsuam xyuas tsis pub dhau 15 hnub raws li Txoj Cai Hais Txog Kev Kawm Ntawv Tshooj. 56321(a). Kuv vam tias cov kev soj ntsuam xyuas no yuav tuaj yeem ua tau tiav sai. Tom qab ntawd, peb tuaj yeem muaj lub rooj sib tham IEP txhawm rau los sab laj txog cov kev soj ntsuam xyuas tau los no thiab npaj qhov phiaj xwm kev kawm txuas mus ntxiv ntawm [Tus Tub Ntxhais Kawm]. Thov xyuas kom paub tseeb tias kuv tau txais cov ntawv theej ntawm cov ntaub ntawv teev tseg txog qhov kev ntsuam xyuas ib lub lim tiam ua ntej yuav qhib lub rooj sib tham IEP kom kuv thiaj li muaj feem koom nrog rau hauv kuv tus menyuam txoj kev kawm tau zoo.  Ua tsaug.
Thov saib siab txog koj,

[Lub Npe]

CC: [Tus Thawj Tswj Xyuas Qhov Xwm Txheej Lub Npe], Tus Thawj Tswj Xyuas Qhov Xwm Txheej ntawm [Tus Tub Ntxais Kawm]