Sample Letter #3 - How to Request Mediation

(Insert date)
(Insert Official's Name)
(Street Address)
(City/State/Zip Code)

Dear Early Intervention Official:

I would like to request mediation. I am concerned about the early intervention services that my child, (insert child's name) is receiving or should be receiving.

I hope you will agree to this request. If so, I understand that someone will contact me to make arrangements for mediation.

The best time to reach me is on (insert days and times).


(Insert Name)
(Street Address)
(City/State/Zip Code)
(Area Code/Phone #)

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