I am the parent of__________, whose date of birth is ______. I am writing to you to request that the school evaluate and provide services to my child under Section 504/Chapter 15. I believe my child is a protected handicapped student because: [list reasons why the child has a physical or mental impairment that substantially limits a major life activity, such as learning, thinking, concentrating, breathing, walking, etc., and provide a specific diagnosis, such as asthma, diabetes, ADD or ADHD, Tourette Syndrome, etc.].