Request For Due Process Proceedings Form
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1
2REQUEST FOR DUE PROCESS PROCEEDINGS
Federal law allows a parent or an attorney representing a child the right to a due process hearing if the parents have a
disagreement regarding the referral, evaluation, classification or placement of their child or the provision of special
education services.
•
All requests for a due process hearing, also known as an impartial hearing, must be submitted in writing.
•
When a due process hearing is requested by the parent, the parent must agree to meet with the school district to try to resolve
the problem before the hearing begins. This meeting, called a Resolution Session, must occur within 15 days after the school
district receives the parent’s due process complaint notice. However, the parent and the school district may agree to pursue
mediation to resolve the problem or may agree to proceed with the impartial hearing, rather than have a Resolution Session.
•
For additional information on special education and the
Procedural Safeguards
Notice, please refer to:
NYSED
Special Education
Publications, and the
Parent
Guide. You may also reach out to specific local resources such as
Special Education Training and Resource
Center,
Parent Centers and Networks
and the
Quality Assurance Regional
Office
of Vocational and Educational Services for Individuals with Disabilities of the NYSED.
Instructions for mailing a request for an Impartial Hearing:
•
Complete both sides of this form and make TWO copies of the original, as well as any additional sheets attached to explain
either the problem or proposed solution. Make sure the child’s name, date of birth and student I.D. number appear on all
documents submitted.
•
Send original to:
Impartial Hearing Office
131 Livingston Street, Room 201
Brooklyn, New York 11201
Fax #: (718) 391-6181
Email: ihoquest@schools.nyc.gov
•
Send copy to:
New York State Education Department, P-12
Office of Special Education
89 Washington Avenue – Room 309 EB
Albany, New York 12234
•
Please keep one copy for your own records.
Check only 1 of the first 3 boxes :
☐ I request an Impartial Hearing be scheduled.
☐ I request Mediation.
☐ I request an Impartial Hearing, but request Mediation instead of the Resolution Session.
Check below if applicable:
☐ There is another due process complaint in process for this student.
☐ There was another due process complaint for this student withdrawn in the past 12 months.
☐ This is an amendment to another due process complaint for this student.
REQUEST FOR DUE PROCESS COMPLAINT NOTICE
*Student’s Name _____________________________________________NYC Student I.D. (OSIS) _______________________
*Student Address ________________________________________*City/State_________________________Zipcode_________
Student’s Date of Birth: ____/____/____
Check here if student is Homeless, in a Correctional Institution, or in Foster Care
Student attends
:
Public School
Charter School
Private School
District# __________
(check one)
CONTINUE ON OTHER SIDE
All asterisked (*) information on both sides of this form must be included when you submit a request for an impartial
hearing. If you or your attorney, do not include the asterisked (*) items on this form, it may result in the denial or delay
of a resolution session and/or a due process hearing and the reduction of attorney’s fees awarded by a court. If the district
believes the notice is not sufficient (does not fully provide the required content information), the district can notify the
appointed impartial hearing officer and you in writing within 15 days of receipt of this notice. The impartial hearing
officer must decide if the notice is sufficient within five days of the sufficiency request and notify both parties in writing.
The information contained in this notice will remain confidential.
Rev.: 4/13/2016
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