[Name]
[Address]
[City, CA, Zip Code]
[Phone number] 
[Date]

[Name of Director]
Director of Special Education
[Name of School District]
[Address]
[City, CA, Zip Code]

Re: Request for Behavioral Emergency Report for [Student Name] and Request for an IEP Meeting

Dear Director [Name]:

I am the [parent/guardian] of [Student name], who is currently enrolled at [school name] in [grade level] in the [name of school district] “District.” I understand that on [date], [describe incident], and the school used an emergency behavior intervention on my [child/student]. 
[NOTE: Emergency behavior interventions can include school staff physically grabbing or holding down a student (restraint) or putting them separate room (seclusion). Click here for more information about what interventions a school can or can’t use.]
Under Cal. Ed. Code Sec. 56521.1(e), the District was required to immediately create a Behavior Emergency Report and to notify me within one school day after using the emergency behavior intervention on [Student name]. I [did/did not] receive a notification within that time period. 
I am writing to request that you send to me a copy of [Student’s] behavioral emergency report. Alternatively, I can pick-up a copy directly from the school. I will call you soon to make arrangements to pick up the report, unless you confirm that I will receive one by email at [email address] or by mail at my home address, [address]. [OPTIONAL: I cannot afford to pay for the copy of [Student’s] report; doing so would effectively prevent me from receiving a copy of the report.]
Additionally, I am requesting an IEP meeting to discuss this incident with [Student’s] IEP team. [OPTION 1: [Student] has a behavior intervention plan (BIP). Per Cal. Ed. Code Sec. 56521.1(h), District must have an IEP meeting to review and revise [his/her/their] BIP because the BIP [does not address the behavior that lead to this emergency behavior intervention [and/or] the BIP does not effectively address [Student’s] behavior]].
[OR OPTION 2: [Student] does not yet have a behavior intervention plan (BIP). Per Cal. Ed. Code Sec. 56521.1(g), District must schedule an IEP meeting within two days of the emergency intervention to determine whether [Student] needs a functional behavioral assessment and whether [he/she/they] needs an emergency behavior plan while [he/she/they] is being assessed. I [have/ have not] received a notice of IEP meeting. [I look forward to meeting on [date] OR I am available to meet on the following dates and times:]

Thank you for your cooperation.

Sincerely,
[Name]