Parents/Guardians/Other Education Rights Holders may wish to include an additional page along with the completed Request for Mediation and Due Process Hearing Form, similar to the following, in order to request stay-put:

Office of Administrative Hearings

State of California 
Special Education Division
2349 Gateway Oaks Drive
Sacramento, CA 95833
Fax: (916) 376-6319

Pending the outcome of the Due Process proceeding I have requested, I am writing to request a stay-put order from the Hearing Office pursuant to 20 U.S.C. Sec. 1415(j), Cal. Ed. Code Sec. 56505(d), and 5 C.C.R. Sec. 3042(a).

My child’s last-agreed-upon special education program and placement is reflected by the attached IEP, which specifies placement in/at:

[INSERT]

and includes the following services and service frequencies:

[INSERT]

The District has threatened to terminate [or change] [or has actually terminated or changed] my child’s last-agreed-upon program/placement as follows:

[INSERT]

I respectfully request the Office of Administrative Hearings to immediately issue a stay-put order which restores my child’s program/placement to its status quo prior to the District’s unilateral [or threatened] actions pending the results of the Due Process Hearing.

Sincerely,