Family Information Notebook (FIN) - Vanderbilt Kennedy Center

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58 SPECIAL EDUCATION ADMINISTRATIVE COMPLAINT To: ATTN: Legal Services Tennessee Department of Education Division of Special Education 5 th Floor, Andrew Johnson Tower 710 James Robertson Parkway Nashville, Tennessee 37243-0380 FAX: (615) 532-9412 From: Name Address City State Zip Code Telephone (Home) Telephone (Work) Child’s Name Child’s Date of Birth Child’s Disability I wish to file an administrative complaint on behalf of at School, in the , a student School System. The specific grounds/reasons for this complaint are as follows: Please investigate this complaint and notify me of the results. I understand that it may be necessary to release a copy of any correspondence submitted by me in relation to this complaint, my name, the name of the child, and the nature of my complaint to local school system officials in order to resolve these issues. Signature Date © Junior League Family Resource Center 2005
DUE PROCESS HEARING REQUEST FORM TENNESSEE DEPARTMENT OF EDUCATION DIVISION OF SPECIAL EDUCATION PARENT INFORMATION (To be completed by parents and returned to the School System for processing) Name of Child Name of Parent / Guardian Child / Parent / Guardian Address City Zip Telephone Number Attorney for Child / Parent / Guardian Attorney's Address City Zip Telephone Number Complete description of the nature of the problem of the child relating to identification, evaluation, educational placement (initial or proposed change) or the provision of a free appropriate public education (FAPE): A proposed resolution of the problem to the extent known and available to the parents: NOTE: Failure on the part of the parents and/or attorney representing the child to comply with this section could cause a reduction in the amount of attorney’s fees if the child is the prevailing party. SYSTEM INFORMATION (LEA must complete information and establish two agreed upon hearing dates) School System System Administrator School System Address City Zip Telephone Number School Attended Disability Attorney for School System Attorney's Address City Zip Telephone Number Date Request Received by School System Place Hearing to be Held Two (2) Agreed upon Dates for Hearing to be Held: Open Closed Mail and/or fax this request along with a copy of the letter from the parent/guardian and/or attorney to: ATTN: Legal Services, Tennessee Department of Education, Division of Special Education, 5 59 th Floor, Andrew Johnson Tower, 710 James Robertson Parkway, Nashville, TN 37243-0380. FAX: (615) 532-9412 © Junior League Family Resource Center 2005
Page 1 and 2:
1 Family Information Notebook (FIN)
Page 3 and 4:
3 TABLE OF CONTENTS Emergency Healt
Page 5 and 6:
5 INTRODUCTION TO EMERGENCY HEALTH
Page 7 and 8: CHILD’S NAME: DATE OF BIRTH: CURR
Page 9 and 10: CHILD’S NAME: DATE OF BIRTH: 9 BA
Page 11 and 12: CHILD’S NAME: DATE OF BIRTH: 11 A
Page 13 and 14: 13 MEDICAL POWER OF ATTORNEY I, ___
Page 15 and 16: 15 Health and Development • Intro
Page 17 and 18: CHILD’S NAME: DATE OF BIRTH: 17 M
Page 19 and 20: Eye Exams 19 CHILD’S NAME: DATE O
Page 21 and 22: At home: 21 CHILD’S NAME: DATE OF
Page 23 and 24: 23 SUGGESTED INFORMATION TO INCLUDE
Page 25 and 26: 25 INTRODUCTION TO DAILY ROUTINE Th
Page 27 and 28: CHILD’S NAME: DATE OF BIRTH: 27 S
Page 29 and 30: 1. Equipment: Who provides (agency,
Page 31 and 32: CHILD’S NAME: DATE OF BIRTH: 31 M
Page 33 and 34: CHILD’S NAME: DATE OF BIRTH: 33 P
Page 35 and 36: CHILD’S NAME: DATE OF BIRTH: 35 T
Page 37 and 38: 37 INTRODUCTION TO EDUCATION / SCHO
Page 39 and 40: CHILD’S NAME: DATE OF BIRTH: Name
Page 41 and 42: Doctor Nurse Teacher CHILD’S NAME
Page 43 and 44: � TEIS Evaluations and ISPs � C
Page 45 and 46: INTRODUCTION TO RESOURCES / OPTIONA
Page 47 and 48: Your Child’s Educational Rights:
Page 49 and 50: 49 Kay Flowers, Complaints Consulta
Page 51 and 52: 51 State Special Schools Tennessee
Page 53 and 54: 53 TENNESSEE DEPARTMENT OF CHILDREN
Page 55 and 56: 55 ADDITIONAL EDUCATION AND HEALTH
Page 57: 57 SPECIAL EDUCATION MEDIATION REQU
Page 61 and 62: 61 INTRODUCTION TO APPENDICES SECTI
Page 63 and 64: Physical Therapist (PT): a licensed
Page 65 and 66: QUALITY HEALTH CARE • There are s
Page 67 and 68: 67 Month: _________________________
Page 69 and 70: F Page Family Resource Center Conta
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