Specific Directions for Completing Required Impartial Hearing Summary Report

The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Vocational and Educational Services for Individuals with Disabilities
Strategic Evaluation Data Collection, Analysis and Reporting
One Commerce Plaza – Room 1624
Albany, NY 12234
REQUIRED IMPARTIAL HEARING SUMMARY REPORT

Please refer to the attached directions and instructions for completing and submitting this report.

PART 1

1. Hearing Requested By: (check one)____Parent(s)____School District
2. Date of Written Request for Hearing:______________
3. Date of BOE Appointment of IHO:______________________

5. School District:_______________________________
6. Optional LEA Case Number:_____________________

8. Expedited Hearing:____Yes____No
9. Was Extension of Time Requested:____Yes ____No (If Yes, answer questions 10 and 11. Otherwise, skip to question 15.)
10. Extension of Time Was Requested By: (check one) ____Parent ____School District ____Joint
11. Was Extension of Time Granted:____Yes ____No (If Yes, answer questions 12, 13, and 14. Otherwise, skip to question 15.)
12. Date(s) the Extension of Time Was Granted by IHO:_______________________________________
13. Total Number of Days Extension of Time Was Granted by IHO: _________Days
14. Reason for Extension of Time: (check all that apply)
    
    

    	Obtain Independent Education Eval.		Obtain Representation		Scheduling
    	Extensive Testimony/Issues		Availability of Exhibits/Witnesses		Other

    
    

15. Date(s) of Hearing:____________________________
    
16. Classification at Time of Hearing: (check one)
    
    

    	Autistic		Emotionally Disturbed		Learning Disabled
    	Deaf		Deaf-Blindness		Hard of Hearing
    	Speech Impaired		Orthopedically Impaired		Other Health Impaired
    	Mentally Retarded		Multiply Disabled		Visually Impaired
    	Traumatic Brain Injury		Preschool Student with a Disability		Unclassified

    
    
    

17. Student’s Placement at Time of Hearing: (check one)
    
    

    	Public School		Charter School		BOCES
    	Approved Private School (Special Ed.)		Interim Alternative Education Setting		Hospital
    	Nonapproved Private School (Special Ed.)		Private/Parochial School (General Ed.)		Home
    	Article 88 (State School for the Deaf)		Article 87 (State School for the Blind)		Home Schooled
    	Article 85 (4201 Schools for Deaf and Blind)		Article 81 (Child Care Institution)		State Agency

    
    
    

18. Issue(s) at Hearing: (check all that apply)
    
    

    	Evaluation		Placement		Manifestation Determination
    	Independent Evaluation		Classification		Appeal of Disciplinary Action
    	IEP/Program		Transportation		Placement in Interim Alternative Education Setting by IHO
    	Tuition Reimbursement for Unilateral Private School Placement by Parent		Procedures		Appeal of Interim Alternative Education Setting
    	Other Reimbursement		Other/Unspecified

    
    
    

19. Date of Decision: ___________________________
20. IHO Decision: (check all that apply)
    
    

    	Support Parent		Support, in part, School District		Stipulation/Agreement
    	Support, in part, Parent		Support, in part, School District and Parent		Remand to CSE/CPSE
    	Support School District		Support Neither Party		Dismissed

    
    
    

21. A copy of the IHO decision and findings of fact are required as PART 2 of the Impartial Hearing Summary Report. Please check "' " the cell below, indicating that such materials are enclosed with this submission.
    
    

22. Impartial Hearing Officer Findings of Fact and Decision*/Stipulation* (These materials constitute PART 2 of the Required Impartial Hearing Summary Report.)

    
    *Pursuant to NYCRR 200.5(c)(11), all personally identifiable information is required to be deleted from the IHO decision and findings of fact submitted to the State Education Department.

23. Printed Name of IHO:__________________________________________
                                                (Please type or print clearly)
    
24. IHO Signature: _______________________________________________
    
    
25. Date Forwarded to SED:_______________________________________

EXHIBITS ENTERED INTO THE RECORD*

*This form is recommended for use by the IHO to ensure that a complete record of the impartial hearing is maintained. If used, this form should be included with the IHO decision and findings of fact sent to both parties. This form should not, however, be submitted to the State Education Department with the Required Impartial Hearing Summary Report.

INDIVIDUALS WHO PROVIDED TESTIMONY AT THE HEARING*

* This form is recommended for use by the IHO to ensure that a complete record of the impartial hearing is maintained. If used, this form should be included with the IHO decision and findings of fact sent to both parties. This form should not, however, be submitted to the State Education Department with the Required Impartial Hearing Summary Report.