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Vocational and Educational Services for Individuals with Disabilities (VESID)
Special Education and Vocational Rehabilitation Services

Available in PDF Format for Printing                                  

December 2006

TO:               School Districts

Individuals and Organizations Interested in the Education of Students with Disabilities

FROM:         James P. DeLorenzo  

SUBJECT:   Sample State Complaint Form

Attached is a Sample State Complaint Form. This model form, which includes all elements required by the Individuals with Disabilities Education Act (IDEA), provides a document to submit a complaint to the New York State Education Department (NYSED). This form can be used when parents, individuals or organizations believe a school district or public agency has violated a requirement of Part B of IDEA or New York State laws or regulations related to students with disabilities. NYSED is required under federal law, 20 U.S.C. 1415(b)(8) and regulation, 34 CFR section 300.509, to develop this model form. Use of this form is not required.  If you choose not to use this form, you must, as appropriate, include in your complaint the required information that is identified on this form.

This sample form and updated versions will be available through the Department’s web site at: http://www.vesid.nysed.gov/specialed/publications/policy. If you have questions about this information, please contact the Office of Vocational and Educational Services for Individuals with Disabilities (VESID), Special Education Policy Unit at 518-473-2878, or your Regional Associate at one of the following VESID Special Education Quality Assurance Regional Offices:

* Please note: If you would like to receive notification of our publications via e-mail, register at
http://www.vesid.nysed.gov/specialed/publications/register.htm.

Attachment - Sample State Complaint Form