SFN 61397REQUEST FOR STATE SYSTEMIC COMPLAINT INVESTIGATION

An individual or organization may file a state systemic complaint with the ND Department of Public Instruction (NDDPI), Office of Specially Designed Services if they believe a public agency has violated a state or federal special education law requirement. This form is for state systemic complaints involving more than an individual child and appearing to result from inappropriate district policies, procedures, or practices. All complaints must be in writing, must be signed, and should identify the alleged violation(s). A complainant can file a state systemic complaint with the NDDPI within one (1) year of an alleged violation.

The ND Department of Public Instruction (NDDPI) will ensure confidentiality, investigate the complaint, and issue a decision within sixty (60) calendar days of receiving the state systemic complaint unless exceptional circumstances extend this timeline. If the NDDPI finds that the public agency has violated requirements relating to special education, the local educational agency will be directed to complete corrective action(s) to correct the violation(s).
Complainant Contact Information
Name of Parent Individual or Organization
Telephone Number
Please enter a valid phone number.
Date of Request

MonthDayYear
Date
Address

Address

Street Address Line 2

CityState

ZIP Code
Check one.

Parent or Person in a Parental RelationshipSurrogate ParentParents' AttorneySchool District/State Agency RepresentativeSchool District/State Agency AttorneyOther
Date, I forwarded a copy of the written state systemic complaint to the school district/public agency.

MonthDayYear
Date
Signature

Clear
Date

MonthDayYear
Date
Would you consider mediation to resolve these issues?

YesNo
School Information
Name of School District (or Public Agency) responsible for providing services
School Representative or Contact (if known)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Complainant Information-Alleged Violation is Systemic (e.g., inappropriate school procedures and/or practices)
A statement that the school district or public agency has violated Part B of IDEA
Describe the fact(s) on which the above statement is based
Proposed Solution(s)
Describe what remedies have been or could be attempted to correct the problem
Should be Empty:

Complainant Contact Information