a. Due Process Hearing/Expedited Hearing

The Impartial Due Process Hearing Forms must be used in connection with requests for Special Education Impartial Due Process Hearings. These forms reflect changes in the hearing process as a result of the reauthorization of IDEA. The forms are to be used as follows:

This form should be available at all conferences and must be given or sent to parents or, upon request, to their representatives as soon as they request a hearing to address issues of identification, evaluation, placement, or the provision of a free appropriate public education. Both sides of the form are to be completed, in full, by the parents or their representative and sent by them to the Arkansas Department of Education, Special Education Unit.

This form should also be available at special education conferences addressing student discipline [suspension beyond ten (10) consecutive school days or expulsion] and must be given or sent to parents or, upon request, to their representative, when they request an expedited hearing, because the parent disagrees with any decision regarding placement under 34 CFR 300.530 and 300.531, or the manifestation determination under 34 CFR 300.530(e). Both sides of the form are to be completed, in full, by the parents or their representative and sent by them to the Arkansas Department of Education, Special Education Unit.

This form should be available at all conferences and must be given to parents or, upon request, to their representative when they request either type of hearing.

This form must be used when the public agency (LEA) requests a hearing to address issues of identification, evaluation, placement, or the provision of a free appropriate public education. Both sides of the form are to be completed, in full, by the public agency's designee or legal representative and sent to the Arkansas Department of Education, Special Education Unit.

This form must be used when the public agency (LEA) requests an expedited hearing, as a result of a disciplinary action [suspension beyond ten (10) consecutive school days or expulsion], to address a need for an interim alternative educational setting for a child with a disability when the LEA believes that maintaining the current placement of the child is substantially likely to result in injury to the child or others. Both sides of the form are to be completed, in full, by the public agency's designee or legal representative and sent to the Arkansas Department of Education, Special Education Unit.

TO: Associate Director, Special Education Unit

FROM: Parent or Attorney Representing the Child

SUBJECT: Request for a Due Process Hearing

Because agreement cannot be reached about the identification, evaluation, or educational placement of, or the provision of a free, appropriate public education to __________ (Name of Child) a due process hearing is requested.

__________ Date: __________

Do you wish to participate in the mediation process? ​ Yes ​ No

(Information on the mediation process will be provided to you by the public agency.)

Do you wish to have an open or closed hearing? ​ Open ​ Closed

The record of the hearing and the Hearing Officer's decision will be provided in written form, unless you specifically request prior to the hearing that these be provided in the form of an electronic record.

Parent(s): __________ Phone: __________ Fax: __________

Address: __________

*Legal or Other Representative: __________

Address: __________ City: __________ State: Zip: __________

Phone: __________ Fax: __________

The Individuals with Disabilities Education Act (IDEA) requires that the information requested below be provided upon request for a due process hearing. This form MUST be completed by the parent of a child with a disability or the attorney or other representative of the child and must be submitted, along with the “Request for Hearing” form, to the Associate Director, Special Education, 1401 W. Capitol, Suite 450, Little Rock, Arkansas, 72201.

(Name of Child and Date of Birth)

(Address of the Residence of the Child)

A description of the nature of the problem of the child relating to the proposed initiation or change, including facts relating to the problem:

A proposed resolution of the problem to the extent known and available to the parents at the time:

TO: Associate Director, Special Education Unit

FROM: Parent or Attorney Representing the Child

SUBJECT: Request for An Expedited Hearing Regarding a Disciplinary Action

Because the parents disagree with:

__________ Date: __________

Do you wish to participate in the mediation process? ​ Yes ​ No

(Information on the mediation process will be provided to you by the public agency.)

Do you wish to have an open or closed hearing? ​ Open ​ Closed

The record of the hearing and the Hearing Officer's decision will be provided in written form, unless you specifically request prior to the hearing that these be provided in the form of an electronic record.

Parent(s): __________ Phone: __________ Fax: __________

Address: __________

*Legal or Other Representative: __________

Address: __________ City: __________ State: Zip: __________

Phone: __________ Fax: __________

The Individuals with Disabilities Education Act (IDEA) requires that the information requested below be provided upon request for a due process hearing. This form MUST be completed by the parent of a child with a disability or the attorney or other representative of the child and must be submitted, along with the “Request for Hearing” form, to the Associate Director, Special Education, 1401 W. Capitol, Suite 450, Little Rock, Arkansas, 72201.

A description of the nature of the problem of the child relating to the proposed initiation or change, including facts relating to the problem:

A proposed resolution of the problem to the extent known and available to the parents at the time:

TO: Associate Director, Special Education Unit

FROM: Public Agency Representative or Attorney Representing the Public Agency

SUBJECT: Request for a Due Process Hearing

Because agreement cannot be reached about the identification, evaluation, or educational placement of, or the provision of a free, appropriate public education to __________ (Name of Child) a due process hearing is requested.

__________ Date: __________

(Signature of Public Agency Official or Representative of the Public Agency)

Do you wish to participate in the mediation process? ​ Yes ​ No

Superintendent: __________ Phone: __________ Fax: __________

Address: __________

Special Education Supervisor: __________ Phone: __________

Address: __________ Fax: __________

*Legal or Other Representative: __________

Address: __________ City: __________ State: Zip: __________

Phone: __________ Fax: __________

This form MUST be completed by the public agency or the attorney representing the public agency and must be submitted, along with the “Request for Hearing” form, to the Associate Director, Special Education, 1401 W. Capitol, Suite 450, Little Rock, Arkansas, 72201.

A description of the nature of the problem of the child relating to the proposed initiation or change, including facts relating to the problem:

A proposed resolution of the problem to the extent known and available to the parents at the time:

TO: Associate Director, Special Education Unit

FROM: Public Agency Representative or Attorney Representing the Public Agency

SUBJECT: Request for An Expedited Hearing Regarding a Disciplinary Action

Because the __________ (Public Agency) believes that maintaining __________ (Name of Child) in the current placement (placement prior to removal to an interim alternative education setting) following a disciplinary action or during the pendency of the due process hearing proceedings is substantially likely to result in the injury of the child or others, an Expedited Hearing is requested.

__________ Date: __________

(Signature of Public Agency Official or Representative of the Public Agency)

Do you wish to participate in a mediation conference? ​ Yes ​ No

Superintendent: __________ Phone: __________ Fax: __________

Address: __________

Special Education Supervisor: __________

Address: __________

*Legal or Other Representative: __________

Address: __________ City: __________ State: Zip: __________

Phone: __________ Fax: __________

This form MUST be completed by the public agency or the attorney representing the public agency and must be submitted, along with the “Request for Hearing” form, to the Associate Director, Special Education, 1401 W. Capitol, Suite 450, Little Rock, Arkansas, 72201.

(Name of Child and Date of Birth)

(Address of the Residence of the Child)

A description of the nature of the problem of the child relating to the proposed initiation or change, including facts relating to the problem:

A proposed resolution of the problem to the extent known and available to the parents at the time:

b. Mediation Process

The Mediation process is to encourage early resolution of problems whenever possible. States are required to offer mediation as a voluntary option to parents and public agencies as an initial process for resolving disputes. Mediation cannot be used to deny or delay a parent's right to a due process hearing or deny any other parental rights under Part B of the Individuals with Disabilities Education Act. Mediation sessions are conducted by a qualified and impartial mediator who is trained in effective mediation techniques. The state education agency shall bear the cost of the mediation process and maintain a list of qualified mediators who are knowledgeable in laws and regulations relating to the provision of special education and related services.

Attorneys shall not participate in the mediation process.

Each session in the mediation process shall be scheduled in a timely manner and shall be held in a location that is convenient to the parties to the dispute.

The parties to the mediation process are required to sign a confidentiality pledge prior to the commencement of such process.

An agreement reached by the parties to the dispute in the mediation process shall be set forth in a legally binding agreement that sets forth that resolution and that states that all discussions that occurred during the mediation process will remain confidential and may not be used as evidence in any subsequent due process hearing or civil proceedings; is signed by both the parent and a representative of the agency who has the authority to bind such agency.

A written, signed mediation agreement under this section is enforceable in any State court of competent jurisdiction or in a district court of the United States. Discussions that occur during the mediation process must be confidential and may not be used as evidence in any subsequent due process hearing or civil proceeding of any Federal court or State court of a State receiving assistance under IDEA.

c. Functional Behavior Assessment (FBA)

Student:__________ Age:__________ Date:__________

At the time of the behavior incident, was a behavior management /intervention plan in place which addressed the behavior(s) which are prompting this review? Yes ​ No ​ If yes, is the behavior management /intervention plan based upon a functional assessment of behavior? Yes ​ No ​

d. Manifestation Determination Review (MDR)

PLACEMENT IN AN INTERIM ALTERNATIVE EDUCATIONAL SETTING

e. Notice Regarding Issues in Parental Private School Placement

PAYMENT FOR EDUCATION OF CHILDREN ENROLLED IN PRIVATE SCHOOL WITHOUT CONSENT OF OR REFERRAL BY THE PUBLIC AGENCY

The public agency (local school district) is not required to pay for the cost of education for your child, including special education and related services, at a private school or facility if the public agency made a free appropriate public education available to your child and you elected to place your child in a private school or facility. However, the public agency must include your child in the population whose needs are addressed consistent with federal requirements at 34 CFR 300.131 - 300.144.

REIMBURSEMENT FOR PRIVATE SCHOOL PLACEMENT

Disagreements between you and the public agency regarding the availability of a program appropriate for your child, and the question of financial reimbursement, are subject to the due process hearing procedures in 34 CFR 300.504 - 300.520.

If you, as the parent of a child with a disability who previously received special education and related services under the authority of a public agency, enroll your child in a private elementary or secondary school without the consent of or referral by the public agency, a court or a hearing officer may require the agency to reimburse you for the cost of that enrollment if the court or hearing officer finds that the agency had not made a free appropriate public education available to your child in a timely manner prior to that enrollment.

LIMITATION ON REIMBURSEMENT

The cost of reimbursement for private school may be reduced or denied -

Notwithstanding the notice requirement described in “1. A and B” above, the cost of reimbursement must not be reduced or denied for failure to provide such notice if,

May, in the discretion of the court or hearing officer, not be reduced or denied for failure to provide such notice if;

f. Surrogate Parent

ON: __________ (Date)

WE HEREBY APPROVE: __________ (Name of Individual)

__________ (Title of Individual) OF __________ (Agency Designation)

AS THE INDIVIDUAL RESPONSIBLE FOR IMPLEMENTING A SURROGATE PARENT

PROGRAM FOR __________

__________ (Name of Child), a student of __________ (Public Agency) has been referred for consideration of the need for special education services. After reasonable effort, the identification or location of a biological or adoptive parent, a legal guardian, a foster parent, or an individual acting in the place of a biological or adoptive parent, (including a grandparent, stepparent, or other relative) with whom the child lives, or an individual who is legally responsible for the child's welfare could not be discovered; or the child is an unaccompanied homeless youth as defined in the federal law; or it has been determined that he/she is a ward of the State. He/she, therefore, meets the criteria for assignment of a surrogate parent.

NAME: __________ HOME PHONE: __________

ADDRESS: __________ BUSINESS PHONE: __________

__________ DATE OF BIRTH: __________

PRIMARY LANGUAGE: __________ OTHER LANGUAGE: __________

IF YOU HAVE A PREFERENCE IN THE ASSIGNMENT OF A STUDENT, PLEASE INDICATE:

SEX: __________ LANGUAGE: __________

NAME: __________

List three (3) persons who know you well:

Are you affiliated with an organization that is promoting or sponsoring surrogate parenting as a public service activity? YES ​ NO ​

If yes, name of organization: __________

Do you feel that you have special skills or traits that would make you an effective surrogate parent? If so, please list.

In consenting to be a surrogate parent, I will:

Please send completed form to:

Dear Mr. Smith:

This letter is to notify you of your official appointment by the Boxwood School District Board of Education as a surrogate parent for Mary Doe, a fifth grade student who attends Harvard Elementary School. Mary has been referred for consideration for receipt of special education services. Mary is suspected of having a disability that interferes with her educational progress. In the near future, you will receive correspondence from us about a meeting to discuss Mary's referral for special education services.

Mary's teacher is Mrs. Lois Wise. Please contact Mrs. Wise to make an appointment to talk with her about Mary's school work. She will also make Mary's school record available to you and will arrange for you to meet Mary.

Please let us know if we can be of assistance.

Sincerely,

Ava Bird, Principal

Harvard Elementary School

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g. Transfer of Rights (age 18)

Dear: __________

In accordance with requirements set forth in the Individuals with Disabilities Education Act (IDEA), Part B, this is to notify you that, since your child with a disability has reached the age of majority under State law (age 18) all rights and protections given to you as the parent of a child with disabilities as contained in “Your Rights Under the IDEA” now transfer to __________ (Name of Child).

However, the IDEA provides that you will retain the right along with your child to receive any notices required under Part B.

Furthermore, such transfer of rights and protections also includes children who are incarcerated in an adult or juvenile Federal, State, or local correctional institution.

The IDEA provides that an exception to this requirement may be made when a child with a disability has been determined to be incompetent under State law. In Arkansas, the determination of an individual's incompetence and appointment of a guardian for that individual must be done by the appropriate court of law.

__________

Dear: __________

In accordance with requirements set forth in the Individuals with Disabilities Education Act (IDEA), Part B, this is to notify you that, since you have reached the age of majority under State law (age 18) all rights and protections previously given to your parent(s) as contained in “Your Rights Under the IDEA” now transfer to you. However, the IDEA provides that your parent(s) will retain the right along with you to receive any notices required under Part B of the IDEA.

For your information, the IDEA provides that such a transfer of rights and protections also includes children and youth who are incarcerated in an adult or juvenile Federal, State, or local correctional institution.

The IDEA provides that an exception to this requirement may be made when a child or youth with a disability has been determined to be incompetent under State law. In Arkansas, the determination of an individual's incompetence and appointment of a guardian for that individual must be done by the appropriate court of law.

__________