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DUE PROCESS HEARING REQUEST NOTICE FORM

1 MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION OFFICE OF SPECIAL EDUCATION - COMPLIANCE DUE PROCESS HEARING REQUEST NOTICE form MODEL form Directions Your due PROCESS HEARING REQUEST must be accompanied by a NOTICE which includes the following information: Name of student and their address Name of agency/district child is attending (optional) Name of school student attends (optional) Name and address of Parent/Guardian Description of the nature of the problem relating to proposed initiation or change to the identification, evaluation, placement, or the provision of a free appropriate public education, and facts relating to the problem. Proposed resolution of the problem to the extent known.

Directions Your due process hearing request must be accompanied by a notice which includes the following information: • Name of student and their address

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