Dispute Resolution in Special Education ~ Exemplar Collection
“Resources and guidance that illuminate and promote exemplary approaches to the design, implementation and improvement of dispute resolution systems.”
| Exemplar Home | State System Profile | Resource Showcase | Videos | Other Resources |
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Process definition: Written State Complaints Critical System Function: Data Tracking/Forms |
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Data Tools - Tracking/Data Collection/Forms |
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RI - State Complaint Submission Tracking Form
RI-21 Compl Submission Tracking Form.pdf |
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| WI - Complaint Processing Worksheet Log
WI-128 Complaints Tracking Log.pdf |
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Sample Complaint Withdrawal Forms |
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| NC - Request to Withdraw Formal Complaint
NC-24 formal-complaint-withdrawal.pdf |
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| NM - Parental Complaint Withdrawal Form
NM-16 Parental complaint withdrawal form_Jan_11.pdf |
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| NM - Parental Complaint Withdrawal Form - Spanish
NM-17 Forma de renunciar un reclamo paternal.pdf |
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Sample Procedural Forms (Internal) |
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| WA - CAP Matrix Shell
WA-13 CAP Matrix Shell.pdf |
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| WA - Complaint Procedures Checklist
WA-2 Part C ComplaintProceduresChecklist-Final-December2010.pdf |
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Sample Reports/Written Decisions |
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Sample Request/Complaint Forms |
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| AR - State Complaint Form
AR-5 State_Complaint_Form.pdf |
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| AZ - State Complaint Form - Part C
AZ-7 Part C State Complaint Form.pdf |
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| CA - Early Start Complaint Investigation Request
CA-9 Part C Complaint Investigation Request 2009.pdf |
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| CA - Part C Complaint Investigation Request - Spanish
CA-13 Part C Complaint Investigation Request - Spanish 2009.pdf |
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| CA - Request for Complaint Investigation
CA-1 Request for Complaint Investigation.pdf |
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| CT - Part C State Complaint Form
CT-7 Part C State Complaint Form.pdf |
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| IA - Model Form to Assist Parent/Guardian in Filing a Complaint
IA-62 Model form parents complaint.pdf |
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| KS - Part C Infant-Toddler Services Formal Complaint Request Form
KS-8 Infant Toddler Services Complaint Form.pdf |
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| MD - Part C Complaint Form
MD-4 Part C Complaint Form7.2012.pdf |
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| MO - First Steps Child Complaint - Model Form
MO-5 Part C State Complaint FormJULY2012.pdf |
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| NC - Model Complaint Form - Spanish
NC-23 formal-complaint-spanish2009.pdf |
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| NC - Model Complaint Form (2009)
NC-21 formal-complaint-form-1.pdf |
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| OK - Formal Complaint Form
OK-58 Formal Complaint Form 5-08.pdf |
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| OK - Request to File a Complaint with OK State Dept of Education
OK-41 Complaint_Request_State 12.11.pdf |
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| OK - Request to File a Complaint with the LEA
OK-42 Complaint_Request_LEA 12.11.pdf |
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| PA - Dept of Education - BSE Complaint Information Packet
PA-240 Complaint Information Packet and Form.pdf |
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| PA - Early Intervention Complaint Form
PA-238 EI Complaint Registry Form.pdf |
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| RI - Model Form to Assist in Filing A Special Education State Complaint
RI-2 State Complaint Model Form.pdf |
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| UT - State Complaint Form
UT-10 statecomplaint.pdf |
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| WA - Part C Dispute Resolution Request Form
WA-1 Part C DR_Request_Rev2012.pdf |
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| WI - Complaint form for parent - release of info from the parent for access to school records
WI-108 RELEASE_form.pdf |
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| WI - IDEA Complaint Form
WI-92 Complaint Form English 12.09.pdf |
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Sample Request/Filing Forms in Other Languages |
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| AZ - Dispute Resolution Form - Part C - Spanish
AZ-10 Part C State Complaint Form - Spanish.pdf |
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| CT - Part C State Complaint Form (Spanish)
CT-6 Part C State Complaint Form (Spanish).pdf |
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| PA - Spanish - Dept of Education BSE Complaint Information Packet
PA-241 Spanish Complaint Information Packet and Form.pdf |
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| RI - State Complaint Model Form - Spanish
RI-11 Sp Ed State Complaint Model Form Spanish Vers Sept 2011.pdf |
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| RI - State Complaint Model Form Portuguese
RI-12 Sp Ed State Complaint Model Form Portuguese VersJAN2011.pdf |
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| WI - Hmong - IDEA Complaint Form
WI-94 Complaint Form_Hmong.pdf |
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| WI - Spanish - IDEA Complaint Form
WI-93 Complaint Form Spanish 12.09.pdf |
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