"Due Process Hearing Request Form" - Idaho

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Due Process Hearing Request Form is a legal document that was released by the Idaho Department of Education - a government authority operating within Idaho.

Form Details:

  • Released on March 1, 2019;
  • The latest edition currently provided by the Idaho Department of Education;
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Download "Due Process Hearing Request Form" - Idaho

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Due Process Hearing Request Form
Special Education
Please submit any request for a due process hearing to the Dispute Resolution Coordinator
via email, postal mail: State Department of Education, PO Box 83720, Boise, ID 83720-0027
or fax to (208) 334-2228. It is also necessary for you to provide a copy of this form to the
school district named below (You may use this form or submit a letter that includes the
information below, including certifying that you have provided a copy to the school district).
A. GENERAL INFORMATION:
Date of Written Request:
___________________________________________________
Name of Individual Requesting:
______________________________________________
Address:
_________________________________________________________________
City:
______________________________
Zip:
____________________
Email:
____________________________
Telephone:
_______________________
Preferred Method of Contact: ☐ Telephone ☐ Email
Relationship to Student:
_________________________________
Name of District /Agency Hearing Request Is Against:
_____________________________
STUDENT INFORMATION:
Student Name: ______________________________________________
Student’s Grade: ____________ Student’s Age: ____________
School Student Attends: ____________________________________________________
Student’s Attorney (if applicable): ____________________________________________
PARENT/GUARDIAN INFORMATION: ☐ Check Here If Same As Requestor
Parent/Guardian Name: ______________________________________________
Address: _____________________________________________________
City: _____________________________________ Zip: ____________________
Email: ________________________________________ Telephone: ___________________
CREATED MARCH 2019
Due Process Hearing
/ Special Education / SDE /
1
Due Process Hearing Request Form
Special Education
Please submit any request for a due process hearing to the Dispute Resolution Coordinator
via email, postal mail: State Department of Education, PO Box 83720, Boise, ID 83720-0027
or fax to (208) 334-2228. It is also necessary for you to provide a copy of this form to the
school district named below (You may use this form or submit a letter that includes the
information below, including certifying that you have provided a copy to the school district).
A. GENERAL INFORMATION:
Date of Written Request:
___________________________________________________
Name of Individual Requesting:
______________________________________________
Address:
_________________________________________________________________
City:
______________________________
Zip:
____________________
Email:
____________________________
Telephone:
_______________________
Preferred Method of Contact: ☐ Telephone ☐ Email
Relationship to Student:
_________________________________
Name of District /Agency Hearing Request Is Against:
_____________________________
STUDENT INFORMATION:
Student Name: ______________________________________________
Student’s Grade: ____________ Student’s Age: ____________
School Student Attends: ____________________________________________________
Student’s Attorney (if applicable): ____________________________________________
PARENT/GUARDIAN INFORMATION: ☐ Check Here If Same As Requestor
Parent/Guardian Name: ______________________________________________
Address: _____________________________________________________
City: _____________________________________ Zip: ____________________
Email: ________________________________________ Telephone: ___________________
CREATED MARCH 2019
Due Process Hearing
/ Special Education / SDE /
1
DISTRICT INFORMATION
Special Education Director Name: _______________________________________
Phone: _____________________ Email: _________________________________
District’s Attorney (if applicable): ________________________________________
B. ISSUE(S): Describe your specific problem that relates to any matter of identification,
evaluation, educational placement, or provision of a free appropriate public education.
Summarize the facts and information as a basis for each allegation.
C. RESOLUTION: Please provide your suggestions for resolving the problem.
CREATED MARCH 2019
Due Process Hearing
/ Special Education / SDE /
2
By my signature below, I certify that a copy of this request for a due process hearing has been
provided to the special education director of the named school district.
Signature of Individual Requesting Hearing
Date
CREATED MARCH 2019
Due Process Hearing
/ Special Education / SDE /
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