EXHIBIT Descriptor Code: FDB-E2
UNITED DISTRICT-LEVEL DISPUTE RESOLUTION FORM
This form is to be completed by a parent, guardian, or unaccompanied student when a dispute arises over school enrollment or transportation assistance. The homeless liaison shall assist the parent, guardian, or unaccompanied student in completing the form.
Complainant name: Complainant contact information: Relation to student: Student’s name: Student’s grade: Date of decision being appealed: Please provide a written explanation to support your appeal:
I have been provided with (please check all that apply):
UNITED DISTRICT-LEVEL DISPUTE RESOLUTION FORM
This form is to be completed by a parent, guardian, or unaccompanied student when a dispute arises over school enrollment or transportation assistance. The homeless liaison shall assist the parent, guardian, or unaccompanied student in completing the form.
Complainant name: Complainant contact information: Relation to student: Student’s name: Student’s grade: Date of decision being appealed: Please provide a written explanation to support your appeal:
I have been provided with (please check all that apply):
- ☐ A written explanation of the district’s decision
- ☐ District dispute resolution procedure
- ☐ Contact information for the State Homeless Education Program Administrator
Complainant signature Date
Please return completed form to the Homeless Student Liaison.
The Homeless Student Liaison shall maintain original form at the school, and provide a copy to the parent, guardian, or unaccompanied youth and the state homeless program administrator at the ND Department of Public Instruction.
Please contact the Homeless Student Liaison, Kayla Andersen, at United School, PO Box 117, Des Lacs, ND 58733-0117, Kayla.Andersen@k12.nd.us, or call 701-725-4334 if you have questions when completing the form.
End of United School District #7 Exhibit FDB-E2