About this Form
Form number: 336-43A
Last revised: April 2017
This form should be completed by a parent/guardian/eligible student to initiate an administrative review addressing: (1) the evaluation of the student; (2) the identification of the student; (3) the educational placement of the student; or (4) the provision of a free appropriate public education for the student. This process is entirely voluntary. An application for a due process hearing may be filed in place of, during, or after the administrative review. Please refer to Board of Education Policy BLC, Procedures for Review and Resolution of Special Education Disputes. Return the application to:
Resolution and Compliance Unit, Montgomery County Public Schools, 850 Hungerford Drive, Room 208, Rockville, Maryland 20850. If you have any questions about the completion of this form, please call 301-517-5864.
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