Parents 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
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:
and includes the following services and service frequencies:
The District has threatened to terminate [or change] [or has actually terminated or changed] my child’s last-agreed-upon program/placement as follows:
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.