Get Md Full Form In Special Education 2012-2024

Org Special Education State Complaint Form Part B of IDEA and COMAR 13A. 05. 01. 15 This is the State Complaint form that the Maryland State Department of Education s Division of Special Education/Early Intervention Services MSDE has developed in accordance with State and federal requirements. Information about the person filing the complaint complainant Complainant s Name Please print Relationship to Student Address if different than the student s Telephone number s Signature of Complainant Date Please note If the complainant is not the parent of the student as defined in IDEA and State law a release of information signed by the parent or legal guardian must be provided to MSDE in order to share personally identifiable information about the student. Complaints must be provided to both Marcella E. Franczkowski M. S. Assistant State Superintendent Maryland State Department of Education Division of Special Education/Early Intervention Services Baltimore Maryland 21201 and The Director of Special Education of the local school system or the public agency against which the complaint is being filed. Updated 07/2012. Karen B. Salmon Ph. D. State Superintendent of Schools 200 West Baltimore Street Baltimore MD 21201 410-767-0100 410-333-6442 TTY/TDD MarylandPublicSchools. While this form is not required for a complaint to be submitted all information included on this form must be provided to MSDE and the public agency responsible for the education of the student before an investigation can begin* Failure to provide the required information or to provide a copy of the complaint to the public agency responsible for the student s education may prevent or delay the resolution of the complaint* Student Information if alleging a violation with respect to a specific student Student s Name Date of Birth Address / City State Zip Code In the case of a homeless student please include any available contact information* School the student is currently attending School where alleged violation occurred if different Check One High School Middle School Elementary School Other Please specify If additional space is needed to answer any of the following questions please use additional paper. The following is a statement of the alleged violation s of IDEA and the facts upon which the statement is based* Please note that the alleged violation s must not have occurred more than one year prior to the date that the complaint is received* Please include any documentation that you have that supports the allegation s to assist MSDE and the public agency to better understand the violation s being alleged* Date s violation s occurred or duration of the violation problem If the complaint is in regard to a specific student please provide a proposed resolution or remedy to address the problem* Please note that this information must be provided in order for MSDE to initiate a State complaint investigation regarding a specific student. Information about the person filing the complaint complainant Complainant s Name Please print Relationship to Student Address if different than the student s Telephone number s Signature of Complainant Date Please note If the complainant is not the parent of the student as defined in IDEA and State law a release of information signed by the parent or legal guardian must be provided to MSDE in order to share personally identifiable information about the student. .