WITHDRAWAL
Due Process &/or Complaint Withdrawal Form
To be filled out for Complaint and/or Due Process Withdrawal only
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CASE NUMBER: _____________________________________________ |
| q COMPLAINT WITHDRAWAL | |
| q DUE PROCESS WITHDRAWAL | |
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This confirms the mediation or settlement agreement between _______________________________________ & ______________________________________________________________, herein after called the "parties," resulted in a mutual agreement between the parties. As a result of the agreement, ________________________________________________________________ hereby withdraws the complaint against____________________________________________________________________________________ that was filed on (mm/dd/yyyy) _________________________________________________. |
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| Parent signature: ________________________________________________ | Date (mm/dd/yyyy): _______________ |
| District representative signature: __________________________________ | Date (mm/dd/yyyy): _______________ |
| Witness signature: _______________________________________________ | Date (mm/dd/yyyy): _______________ |
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| Effective July 1, 2008 | |
| July 1, 2008 | |
| Whose IDEA Is This? A Parent's Guide to the Individuals with Disabilities Education Improvement Act of 2004 |
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Please mail and/or fax to:
Ohio Department of Education
Office for Exceptional Children
Mediation Coordinator
25 South Front Street, Mail Stop 202
Columbus, OH 43231-4183
Phone: (614) 752-1679
FAX: (614) 728-1097