Special Education Dispute Resolution

Dispute Resolution Online Complaint Form

Online State Complaint Web Form

Any individual or organization may file a signed written complaint under the procedures described in 34 C.F.R §§ 300.151-300.153. The complaint must include a statement that a public education agency (PEA) has violated a requirement of Part B of the individuals with Disabilities Education Act of 2004 (IDEA ’04) and the facts on which the statement is based. The complaint must allege a violation that occurred not more than one year prior to the date that the complaint is received in accordance with 34 C.F.R §§ 300.151. Example: If the alleged violation occurred on September 15, a state complaint must be filed by the close of business September 14 of the following year.

Although it is not required in order to file a complaint, you may use this form if you believe a PEA that is responsible for the provision of special education services has violated requirement(s) of Part B of IDEA ’04, its implementing regulations, or the corresponding special education requirements found in the Arizona Revised Statutes (ARS), and/or the Arizona Administrative Code (AAC). The party filing the complaint must forward a copy of the complaint to the Public Education Agency (District / Charter) serving the child at the same time the party files the complaint with the Arizona Department of Education/ Exceptional Student Services /Dispute Resolution (ADE/ESS/DR).

This form is designed for you to provide ADE/ESS/DR with information needed in order to accurately process your complaint.

Please Note: This form is best viewed using Chrome, Firefox or Edge browsers.

* indicates required information

Student Information

The Arizona Department of Education – Dispute Resolution Unit is ONLY authorized to investigate allegations regarding special education. Examples of allegations that Dispute Resolution cannot investigate include allegations of abuse, neglect, discrimination, retaliation, harassment, civil rights violations, employment matters, Section 504 plans, school policy matters, or anything not specifically related to special education.

Student Involved in Allegation

Please list the student or students who were involved in this allegation. If you need to add more than one student, please click on the add student button below.

Selected?	First Name	Last Name	Date of Birth	Grade
Is Selected?	First Name	Last Name	Date of Birth	Grade

Complainant Information

Complainant Name *

The information below is related to the person submitting this complaint.
First Name
Last Name

Address *

The information below is related to the person submitting this complaint.

Street Address

Address Line 2

City

State

Zip Code

Email Address

Please enter an email address where you can be reached.

Phone Number *

Please enter a primary phone number where you can be reached.

Parent Information

Please specify if you are submitting this complaint as the parent or the guardian of the student(s) named above.
If you are neither the parent nor the guardian, please select the ‘other’ button and enter a description in the corresponding field.

Parent Information

Parent

Guardian

Other

Parent or Guardian Names

Please click on the Add Parent button to add additional parent/guardian names.

Selected?	First Name	Last Name	Phone Number
Is Selected?	First Name	Last Name	Phone Number

Email Address

Please enter an email address where you can be reached.

District and School Information

Please select the District or Charter School related to this complaint.

District/Charter School Name

Please select a District or Charter School from the list below.

School Name*

Please enter the name of the school involved with the complaint.

Allegation Information

What is the Alleged Violation(s)?*

Please summarize the allegation(s) below.

What are the facts or evidence on which the allegation is based?

Please summarize the facts below for each allegation.

What are significant dates and events that may be relevant to this allegation?

Please summarize the dates and events below for each allegation.

What documents should be reviewed for each allegation?

Please upload any relevant documents.
Upload Documents...

What ideas do you have to resolve the issue(s)?*

Mediation Option

Check any applicable boxes
Mediation is available to parents at no cost and can be entered into with the agreement of the Charter or District. Mediation allows parents and schools to communicate directly with each other as they work with a trained mediator toward a mutually agreeable solution. Mediation may proceed at the same time as the complaint investigation.

I request mediation and authorize the District/Charter and Arizona Department of Education to share educational information with the mediator about my student’s identity, educational needs, and information pertinent to the mediation. I understand the mediator will keep this information confidential.

I would like more information about mediation.

Signature of Person Signing the Complaint

Please hover your mouse over the field and sign your name using the virtual pen.

Signature*

Note: Click on the symbol above to erase the signature.

Questions concerning this form or the complaint process may be addressed by contacting:

Arizona Department of Education
Attn: Director of Dispute Resolution
1535 West Jefferson, Bin # 62
Phoenix, Arizona 85007
Phone: (602) 542-3084 Fax: (602) 364-0641
Email: [email protected]

If you do NOT submit from this website, please send copies of any relevant documents and the completed forms to the above address or fax number.

Additionally: If you have submitted your state administrative complaint outside of regular business hours it will be considered received by Dispute Resolution on the next business day.