Form DES-P12 "Statement of Complaint" - Michigan

What Is Form DES-P12?

This is a legal form that was released by the Michigan Department of State - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2020;
  • The latest edition provided by the Michigan Department of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DES-P12 by clicking the link below or browse more documents and templates provided by the Michigan Department of State.

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STATEMENT OF COMPLAINT
Michigan’s
Michigan Department of State
Driver Education
DES-P12
12/2020
Michigan Department of State
Driver Education Section
430 W. Allegan St.
Lansing, MI 48918
Prior to completing a Statement of Complaint form, it is highly recommended that you read ALL the information below which will help you
understand the Department’s functions, roles, and responsibilities.
WHAT WE REGULATE
The Secretary of State, under the authority of Public Act 384 of 2006, is responsible for certifying and regulating all driver education
providers and instructors. The Driver Education Provider and Instructor Act [DEPIA, 2006 PA 384] provides the department with the
regulatory function of reviewing within or outside this state and gathering evidence against a person that violated, allegedly violated, or is
about to violate this act, a rule promulgated under this act, or an order issued under this act, in addition to whether a person, an applicant, a
driver education provider, or a driver education instructor is in compliance with this act or a rule promulgated under this act.
The Driver Education Provider and Instructor Act provides clear authority to the Secretary of State to deny, suspend, or revoke a
certification if the certificate holder or applicant has not complied with the provisions of the Act. Disciplinary actions may be resolved in an
alternative manner to ensure compliance and may include a written warning, probation, administrative fines, or suspension. If compliance
cannot be achieved in an alternative agreement, then the Secretary of State may seek formal administrative actions.
WHAT WE CANNOT DO
Since we are not a court of law, there are many items we cannot act upon such as:
Voiding contracts.
Awarding damages.
Act as your attorney.
Matters involving the internal affairs of a business entity.
Conducting criminal prosecutions.
If you have further concerns, we suggest you consult with an attorney.
HOW YOU CAN HELP US
Summarize your allegations using these guidelines:
 Tell us WHAT happened. Start from the beginning. Be specific as to what was said and who said it.
 Tell us WHO was present during these conversations or acts.
 Tell us WHEN and WHERE these conversations/acts took place.
 Tell us WHEN and WHERE the money and agreements changed hands.
 Tell us HOW you believe that you were taken advantage of.
 Attach photocopies of all documents such as contracts, agreements, certificates, notes, correspondence, legible copies of the front and
back of checks involved, prospectus, advertising, etc. Documentary evidence is especially important. Please do not send originals; we
cannot be responsible for their safekeeping and they will not be returned.
 The Department may ask you to provide other documents later to support your allegations.
WHAT HAPPENS NEXT
 The Department will email you a Received Confirmation letter for receipt of the Statement of Complaint within 5 non-holiday business
days after it has been received.
 If the Statement of Complaint alleges violations of the laws and regulations administered by the Department, the Department will
investigate.
 If the Department does not have jurisdiction over the matter, you will be notified in writing.
Page 1 of 2
STATEMENT OF COMPLAINT
Michigan’s
Michigan Department of State
Driver Education
DES-P12
12/2020
Michigan Department of State
Driver Education Section
430 W. Allegan St.
Lansing, MI 48918
Prior to completing a Statement of Complaint form, it is highly recommended that you read ALL the information below which will help you
understand the Department’s functions, roles, and responsibilities.
WHAT WE REGULATE
The Secretary of State, under the authority of Public Act 384 of 2006, is responsible for certifying and regulating all driver education
providers and instructors. The Driver Education Provider and Instructor Act [DEPIA, 2006 PA 384] provides the department with the
regulatory function of reviewing within or outside this state and gathering evidence against a person that violated, allegedly violated, or is
about to violate this act, a rule promulgated under this act, or an order issued under this act, in addition to whether a person, an applicant, a
driver education provider, or a driver education instructor is in compliance with this act or a rule promulgated under this act.
The Driver Education Provider and Instructor Act provides clear authority to the Secretary of State to deny, suspend, or revoke a
certification if the certificate holder or applicant has not complied with the provisions of the Act. Disciplinary actions may be resolved in an
alternative manner to ensure compliance and may include a written warning, probation, administrative fines, or suspension. If compliance
cannot be achieved in an alternative agreement, then the Secretary of State may seek formal administrative actions.
WHAT WE CANNOT DO
Since we are not a court of law, there are many items we cannot act upon such as:
Voiding contracts.
Awarding damages.
Act as your attorney.
Matters involving the internal affairs of a business entity.
Conducting criminal prosecutions.
If you have further concerns, we suggest you consult with an attorney.
HOW YOU CAN HELP US
Summarize your allegations using these guidelines:
 Tell us WHAT happened. Start from the beginning. Be specific as to what was said and who said it.
 Tell us WHO was present during these conversations or acts.
 Tell us WHEN and WHERE these conversations/acts took place.
 Tell us WHEN and WHERE the money and agreements changed hands.
 Tell us HOW you believe that you were taken advantage of.
 Attach photocopies of all documents such as contracts, agreements, certificates, notes, correspondence, legible copies of the front and
back of checks involved, prospectus, advertising, etc. Documentary evidence is especially important. Please do not send originals; we
cannot be responsible for their safekeeping and they will not be returned.
 The Department may ask you to provide other documents later to support your allegations.
WHAT HAPPENS NEXT
 The Department will email you a Received Confirmation letter for receipt of the Statement of Complaint within 5 non-holiday business
days after it has been received.
 If the Statement of Complaint alleges violations of the laws and regulations administered by the Department, the Department will
investigate.
 If the Department does not have jurisdiction over the matter, you will be notified in writing.
Page 1 of 2
STATEMENT OF COMPLAINT
Michigan’s
Michigan Department of State
Driver Education
DES-P12
12/2020
Michigan Department of State
Driver Education & Testing Section
430 W. Allegan St.
Lansing, MI 48918
Clear Form
PART A – SUBJECT OF COMPLAINT
(Who this complaint is being filed upon.)
Certified Instructor Preparation Program Agency
Certificate Number(s) (If known)
Certified Instructor Preparation Program Instructor
Agency / Instructor Name
Phone Number
Address (Number and Street)
City
State
Zip Code
PART B – PLAINTIFF
(Person filing the complaint.)
Name (First, Middle, Last)
Street Address
City
State
Zip Code
Email Address
Phone Number
PART D – DETAILS OF COMPLAINT
E – CERTIFICATION
 I understand the information provided will not be returned, will be used for investigative purposes, and may be subject to release under
the Freedom of Information Act.
 I hereby certify that the statements and information contained within this document are true to the best of my knowledge and belief.
Print Name of Complainant
Signature of Complainant
Date Signed
This Statement of Complaint and supporting documents can be submitted to our office by:
 Email:
drivered@Michigan.gov
 Fax: 517-335-3155
 Mail: Michigan Department of State  Driver Education & Testing Section  430 West Allegan Street  Lansing, MI 48918
Thank you for contacting the Secretary of State.
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