Nebraska Administrative Code
Topic - EDUCATION, DEPARTMENT OF
Title 92 - NEBRASKA DEPARTMENT OF EDUCATION
Chapter 28 - PROFESSIONAL PRACTICES INVESTIGATIONS AND NONPUBLIC CERTIFICATE HEARINGS
Appendix B - Sample Form for Petition
BEFORE THE STATE BOARD OF EDUCATION STATE OF NEBRASKA
___________________________________ )
(Name of Commissioner) ) CASE NO. (LEAVE BLANK)
)
COMMISSIONER OF EDUCATION, )
___________________________________ )
(Address) )
__________________________________, )
)
Petitioner, )
)
vs. ) PETITION
)
___________________________________ )
(Name) )
___________________________________ )
(Address) )
__________________________________, )
)
Respondent. )
Petitioner, in accordance with Title 92, Chapter 28, of the Nebraska Administrative Code, states and alleges as follows:
1. The full name, address, and telephone number of the petitioner;
2. The full name, address, telephone number, and the social security number, if known, of the respondent;
3. The type, rank, level, endorsements, and expiration dates of certificate(s) held by respondent;
4. The name of the school or school district, if any, currently employing the respondent;
5. A concise statement of the facts which the petitioner believes constitute a violation of professional ethics and practices;
6. The full names, addresses, and telephone numbers of any witnesses able to testify as to the facts alleged; and
7. Citation of statute or regulation which was allegedly violated.
WHEREFORE, petitioner requests that the State Board of Education investigate this petition and take such action as is warranted, regarding the certification of respondent.
Dated this _______ day of _______________, 19___.
________________________________
(Signature)
(If attorney for petitioner, list address)
VERIFICATION
State of Nebraska )
) ss
County of _________ )
I, ________________________, being first duly sworn under oath, state that I have read the contents of the petition and that to the best of my knowledge, information, and belief such contents are true and there is reasonable cause for filing said document.
Subscribed and sworn before me this _______ day of ____________, 19___, by
(Name of Commissioner) .
(Seal)
_____________________________
Notary Public
