Form Pi-2115 - Request For A Due Process Hearing

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Wisconsin Feem Kev Cob Qhia Pej Xeem
COV KEV QHIA UA: Ua 3 daim. Khaws ib daim rau koj tau saib. Muab ib
daim rau Tsoom Fwv Tsev Kawm Ntawv pov plob rau tus me nyuam txoj
DAIM NTAWV THOV LUB ROOJ SIB HAIS
kev kawm. Muab ib daim foos rheev npe xa mus rau:
Section 115.80, Wis. Stats.
DIRECTOR
PI-2115 (Rev. 10-10)
SPECIAL EDUCATION TEAM
WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
P. O. BOX 7841
MADISON, WI. 53707-7841
FAX: 608-267-3746
Daim foos no tau tsim los pab cov niam txiv thov lub rooj sib hais. Yuav tau teev txhua yam ntsiab lus. Yog tias tsis teev txhua yam yuav raug tsev
hais plaub txo txhua yam nqi kws lij choj. Feem saib xyuas koj tsab ntawv thov lub rooj sib hais mam hais tuaj rau koj.
CIA RAU DPI SIV XWB
Hnub Tau Txais (Date Received)
Tus Case No. Tau Muab Rau (Case No.)
Hnub Ua Kom Tiav (Due Date)
TXHUA YAM NTSIAB LUS
Lub Npe Ntawm Tus/Cov Neeg Thov Lub Rooj Sib Hais
Kev Txheeb Ze Rau Tus Me
Nyuam
Chaw Nyob Ntawm Cov Neeg Thov Lub Rooj Sib Hais
Txoj Kev, Nroog, Xeev, ZIP
Tus Xov Tooj Area/No.
Tus Me Nyuam Npe
*Qhov Chaw Nyob Ntawm Tus Me Nyuam Nyob Txoj Kev, Nroog, Xeev, Zip
Cheeb Tsam Tsev Kawm Ntawv Ntawm Tus Me Nyuam Nyob
Cheeb Tsam Tsev Kawm Ntawv Tus Me Nyuam Kawm
Piav qhov teeb meem tus me nyuam muaj cuam tshuam rau tes hauj lwm tau plov meej ntawd, xws li tej ntsiab lus hais txog qhov teeb meem. Teev tej
txheej xwm rau qhov xav thov lub rooj sib hais. Siv ib daim ntawv ntxiv los yog siv sab tom qab yog tsis txaus sau.
Lub ntsiab lus xaus ntawm qhov teeb meem uas tau plov meej (yog tias paub thiab muaj rau cov niam txiv rau lub sij hawm no). Siv ib daim ntawv ntxiv
los yog siv sab tom qab yog tsis txaus sau.
MEM TES RHEEV NPE
Tus/Cov Neeg Thov Lub Rooj Sib Hais Tus Mem Tes Rheev Npe
Hnub Tau Rheev Npe
*Rau cov me nyuam tsis muaj vaj tsev nyob, muab xov tooj chaw nyob thiaj tau sib nug [34CFR 300.153 (b)(4)(iii); 300.508 (b)(4)]

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