The parent or the school may file a due process complaint on any matter relating to a proposal or a refusal to initiate or change the identification, evaluation, educational placement or the provision of a Free Appropriate Public Education (FAPE) to a child. The due process complaint must allege a violation that happened not more than two years before you or the school knew or should have known about the alleged action that forms the basis of the due process complaint. Unless, the parent was prevented from filing a due process complaint under one of the allowable exceptions listed in 34 CFR §300.511(f).
GENERAL INFORMATION
* Name of Student: Gender: Female Male Date of Birth: / /
Month / Day / Year
* Address of Student: Age: Grade:
(If homeless, may use available contact information)
N ame of Parent/Guardian: Home/Cell Number: ( ) -
A ddress of Parent/Guardian: Work Number: ( ) -
*Name of School Student attends:

SUMMARY OF COMPLAINT
*Describe the nature of the complaint. Include facts relevant to the dispute (attach additional pages as necessary):
*Briefly explain the resolution you are seeking (attach additional pages as necessary):
Signature of Parent/Guardian or Person filing the request Date
P lease contact the Bureau of Indian Education, Division of Performance and Accountability, Special Education at (505) 563-5264 for additional information. This Request for Due Process Hearing form or if using another document (i.e. letter) that document must be provided to the other party and mailed, faxed or hand-delivered to:
Bureau of Indian Education
Division of Performance and Accountability
Attention: Supervisory Education Specialist – Special Education
1011 Indian School Rd, Suite 332
Albuquerque, NM 87104
Fax: (505) 563-5233
*IDEA 2004 content requirements Revision September 2010
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