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Florida Bureau of Exceptional Education and Student Services
IDEA State Complaint Form
Required by IDEA 2004, 34 CFR §§ 300.151-153, 300.509.
Use of this form is voluntary.
This form can be used by any individual or organization for filing a formal state complaint with the Florida Department of
Education when alleging that the school district or state has violated the educational rights of a student with a disability,
under the Individuals with Disabilities Education Act (IDEA 2004) and corresponding state requirements. This form is also
used for filing a state complaint for a violation of the educational rights of students who are gifted, according to state
requirements. Provision of all information is requested. Failure to provide information may delay the complaint
investigation. The use of an asterisk (*) indicates information required per federal regulation for the filing of an IDEA
State Complaint.
*Name of Complainant:
Relationship to Student:
Complainant Email Address:
*Complainant Address (Street, City, State, ZIP)
*Daytime Telephone Number:
I am alleging that the following named school district or public agency
has violated Part B of the Individuals with Disabilities Act or related
state rules or laws regarding the education of a student with a disability
or a gifted student:
YES
NO
*Name of School District or Public Agency
*Name of Student:
Student Age or Grade:
*School Name:
*Student Address (Street, City, State, ZIP)
Date(s) of alleged violation:
Student Exceptionality:
☐ Check here to receive correspondence via email.
By checking this box, you are giving the bureau permission to send all correspondence and reports by electronic mail
to the email address identified above. All electronic mail will be sent password protected.
State Complaint:
I understand I must include the facts that support my allegation(s).
I also understand that the complaint must allege a violation that occurred not more than one year prior to the
date that the complaint is received by the Bureau.
*DESCRIPTION OF ALLEGED VIOLATION(S) (student specific allegations only):
☐
☐
*FACTS RELATING TO ALLEGATION(S):
*PROSOSED REMEDY, RESOLUTION OR SOLUTION (student specific allegations only):
☐
I have included attachments to this complaint.
Alternative resolution is a voluntary process available to parents at no cost and can often result in more expedient
resolution of conflicts. This may proceed concurrently with the complaint investigation process. Please indicate your
interest in the options below:
I am interested in and would like more information on legally binding mediation where the district and I agree to
meet with an assigned mediator to create a legally binding mediation agreement. (This option is only available
to the parent(s) or guardian(s) of the student or the adult student per Florida Rule.)
I am interested in and would like more information on a state-facilitated individual educational plan (IEP) team
meeting where the bureau assigns a facilitator to attend an IEP team meeting. (This option is only available to
the parent(s) or guardian(s) of the student or the adult student per federal and state law.)
I understand I will be contacted by the bureau staff assigned to my case to:
Advise me of my rights to alternative resolution activities such as early resolution or mediation
Clarify and review my complaint facts
Request submission of additional information or documentation to support my statement (if needed)
Date:
*Signature of Complainant:
*A copy of your IDEA State Complaint must be submitted to your local school district or other local education
agency at the same time this complaint is filed with the department. Submit signed original via fax, email or US mail
to:
Florida Department of Education
Bureau of Exceptional Educational and Student Services
Dispute Resolution and Monitoring Unit: State Complaint
325 West Gaines Street, Suite 614
Tallahassee, FL 32399-0400
Email: BEESScomplaints@fldoe.org
Fax: 850-245-0953
Phone: (850) 245-0475
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Completed 22 August 2021

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