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Sample Due Process Complaint Notice Form To Request An Impartial Hearing

March 2014

Attached is a revised sample Due Process Complaint Notice to provide parents and school districts with a model form to assist in filing for a due process proceeding (impartial hearing) relating to the identification, evaluation, or educational placement of a student with a disability or a student suspected of having a disability or the provision of a free appropriate public education to such student.  The form has been revised to request information from parents who request an impartial hearing as to whether they have another impartial hearing pending or, within the prior year, had requested an impartial hearing and subsequently withdrew their request.  This information will assist school districts to timely appoint an impartial hearing officer.

The New York State Education Department is required under federal law and regulations to develop this model form.  School districts must provide information to parents about the availability of this form.  School districts, parents or their attorneys may choose to use this form or provide the information in another format.  However, failure to provide the required information as noted on the sample form may result in the delay or denial of a resolution session and/or a due process hearing and the reduction of attorneys' fees that may be awarded by a court.   

This sample form may be used to submit a complaint (also known as a request for an impartial hearing) to resolve a disagreement about the identification, evaluation or placement of a student with a disability or a student suspected of having a disability or regarding the provision of a free appropriate public education for such student under the Individuals with Disabilities Education Act (IDEA).

If you have questions about this information, please contact the Office of Special Education at 518-473-2878 or your Special Education Quality Assurance Regional Office.