Due Process Request Form

Due Process Request Form

(to be hand delivered or sent by certified mail)

Date: _______________________

_______________________, Superintendent

_______________________

_______________________

Re: (Name of Student, Age, Date of Birth)

Dear Superintendent ______________:

Please treat this correspondence as a formal request for a due process hearing pursuant to 105 ILCS 5/14-8.02a, 23 Illinois Administrative Code §226.615, 20 U.S.C. 1415(b)(7) and 34 CFR 300.507 and 300.508.

I. Name of Child:

   The name, age, and date of birth of the child are stated above.

II. Address of Child's Residence:

     Address: ____________________________________________________

     City/State/Zip: _______________________________________________

     Phones: _____________________________________________________

III. Name of School the Child is Attending:

      _____________________________________________________________________

      _____________________________________________________________________

IV. Description of the Nature of the Problem, Including Facts Relating to the Problem:

     _____________________________________________________________________

     _____________________________________________________________________

V. Proposed Resolution of the Problem to the Extent Known and Available at the Present Time:

    _____________________________________________________________________

    _____________________________________________________________________

For the above listed reasons, it is our position that the district has failed to provide our child with a free appropriate public education as required by state and federal law. We will participate in state sponsored mediation efforts.

Sincerely,

_________________________________________
Parent(s)