Special Education:
To:
From:
Parents' Names
Address
Phone Number
Date:
1. Child
Child's Name: Date of Birth:
Child's Address:
School or Program Child Attends:
2. Problem: Parents can request a hearing if they disagree with the identification, evaluation, educational placement or provision of a free appropriate public education to their child.
Describe the problem with your child's special education program, and the specific actions that the school district or EI/ECSE program has taken or refused to take. Include facts about the problem. You can attach more pages if you need more space.
3. Proposed Solution: Describe what you think needs to be done to solve the problem. If you know or have any specific ideas at this time. You can attach more pages if you need more space.
4. Mediation: Mediation services are available from the Department at no cost to parents or school district when a hearing has been requested and the parties agree to mediate.
Are you interested in mediation to try to resolve the problem or dispute?
Do you need more information to decide?
5. Additional Information: [School age children only - age 5 - 21]
What is your resident school district?
Note: Resident school district is typically the school district in which the parent resides, even if the child attends school in a different school district.
Letter, courtesy of Oregon Department of Education. Note, it is not necessary that you use this form as long as the required information is included in your request for a due process hearing. See How do I request a due process hearing?