Special Education

Cover - Revised Sample State Complaint Form

February 2010

District Superintendents
Superintendents of Schools
Presidents of Boards of Education
New York City Board of Education
Superintendents of State-operated and State-supported Schools
Principals of Public Schools                  
Directors of Pupil Personnel Services
Executive Directors of Approved Private Schools
Approved Preschool Special Education Programs
Chairpersons of Committee on Special Education
Chairpersons of Committee on Preschool Special Education
Organizations, Parents and Individuals Concerned with Special Education
Impartial Hearing Officers
Commissioner’s Advisory Panel for Special Education Services
Regional Special Education Technical Assistance Support Centers
Special Education Quality Assurance Offices
James P. DeLorenzo

Revised Sample State Complaint Form

Attached is a revised Sample State Complaint Form.  This model form, which includes all elements required by the Individuals with Disabilities Education Act (IDEA), provides a document to submit a complaint to the New York State Education Department (NYSED).  This form can be used when parents, individuals or organizations believe a school district or public agency has violated a requirement of Part B of IDEA or New York State laws or regulations related to students with disabilities.  NYSED is required under federal law, 20 U.S.C. 1415(b)(8), and regulation, 34 CFR section 300.509, to develop this model form.  Use of this form is not required.  If this form is not used, the complaint still must include the required information that is identified on this form.

This sample form and updated versions will be available through the Department's website at: http://www.p12.nysed.gov/specialed/formsnotices/samplecomplaint.htm.  A question and answer document clarifying the procedures used by NYSED in the investigation and resolution of State complaints which allege that a school district or public agency has violated federal and New York State law or regulation relating to students with disabilities is available at http://www.p12.nysed.gov/specialed/quality/complaintqa.htm.  If you have additional questions about this information, please contact the Office of Vocational and Educational Services for Individuals with Disabilities (VESID), Special Education Policy Unit at (518) 473-2878, or your Regional Associate at one of the following VESID Special Education Quality Assurance Regional Offices:

Central NY Regional Office                    (315) 476-5081
Eastern Regional Office                         (518) 486-6366
Hudson Valley Regional Office               (914) 245-0010 or (518) 473-1185
Long Island Regional Office                   (631) 884-8530
New York City Regional Office                (718) 722-4544
Western Regional Office                        (585) 344-2002

Please note:  If you would like to receive notification of our publications via e-mail, register at http://www.p12.nysed.gov/specialed/publications/register.htm

Attachment – Sample State Complaint Form



Last Updated: December 10, 2012