Elementary and Secondary Education Act (ESEA) Complaint Form

Use this form to file a complaint regarding the implementation of ESEA requirements. All requested information is required for the complaint to be reviewed.

Do not complete this form unless you have first attempted to resolve the issue at the local level. More information about the ESEA complaint process is available on the CDE website (www.cde.state.co.us). This process applies specifically to non-public school officials to document complaints related to lack of timely and meaningful consultation with an LEA or lack of provision of equitable services as required by the ESEA. However, other parties may also utilize this form. A response is required for each question unless it is labeled “optional.”

For non-public school officials submitting a complaint related to Equitable Services, a decision will take up to 45 calendar days, and the decision will be sent to the involved parties electronically, unless requested otherwise. If warranted, the complaint review process may include an on-site visit to the school location. If extenuating circumstances exist that will extend the complaint review process beyond 45 calendar days, all involved parties will be notified. Appeals to the decision of CDE can be made to the United States Department of Education within 30 days after the state’s 45 day window. Appeals will be reviewed at the discretion of the Secretary of Education.

For more information, contact Federal Programs Ombudsman, Christina Adeboye Sullivan or 720-498-2252.

District*

School/Agency/School Employee*

Name of Person or Party Filing Complaint*

Student Name(s)- Optional

Street Address of Complainant*

City Address of Complainant*

Phone Number of Complainant*

Email Contact of Complainant*

Context and Background*

Please provide a brief overview of the situation resulting in the complaint.

Statement*

Statement of the ESEA requirement(s), statute(s), regulation(s) or program(s) reported to be in violation:

Complaint*

Actions, Facts, and Documentation*

The actions, facts (including dates) and documentation that form the bases of the complaint:

Description and documentation of efforts*

Description and documentation of the efforts to resolve the complaint at the local level and the results of those efforts (Please attach any supporting documentation to the signed complaint)

Description of the resolution being sought*

Signature*

Please upload a signature of the person filing the complaint.

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Date*

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