Request for Evaluation (Private School Students)
Complete this form to request a Special Education evaluation for a student attending a private or religious school within the Tomball ISD attendance zone. It is not required that the parent submit the request, but the parent must be informed and provide consent for the evaluation to proceed.

DO NOT LIST THE STUDENT'S NAME. A representative from the Student Support Department will contact you to obtain student demographic information.

Name of Person Submitting Form
Your answer
Phone Number of Person Submitting Form
Your answer
e-mail of Person Submitting Form
Your answer
Is the child/student zoned to Tomball ISD
If the child/student is zoned to Tomball ISD, which school?
Your answer
Name of Private or Religious School
Your answer
Is the student home-schooled?
Student's Grade Level
Student's Age
Your answer
Name of Student Referred for a Special Education Evaluation
Your answer
Area of the Suspected Disability
Identify the area of suspected disability by clicking one or more of the boxes below. The selection below assists in guiding the evaluation, but may change once the evaluation begins.
What curriculum area(s) does the student struggle?
Identify the area(s) of the curriculum in which the student struggles the most, click more than one box if needed.
Identify the number of words the students is able to read on grade-level per minute.
The number of words read per minute (WPM) is one indicator of the student's overall reading ability.
List the student's grades on the most current report card
Reporting grades assist the evaluation team in understanding the level of educational need.
Your answer
Describe the student's performance on major assessments?
Assessment performance also provides the evaluation team information on the level of education need demonstrated by the student. Include any school, state or national test results if available.
Your answer
In general describe the student's struggle in the classroom in comparison to same age peers from your perspective.
Your answer
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