Neb. Admin. Code EDUCATION, DEPARTMENT OF, tit. 92, ch. 28, app A
BEFORE THE COMMISSIONER OF EDUCATION STATE OF NEBRASKA
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(Name)) CASE NO. (LEAVE BLANK)
___________________________________)
(Address))
__________________________________,)
)
Complainant,)
)
vs.) COMPLAINT
)
___________________________________)
(Name))
___________________________________)
(Address))
__________________________________,)
)
Respondent.)
In accordance with Title 92, Chapter 28, of the Nebraska Administrative Code, the complainant states as follows:
1. The full name, address, and telephone number of the complainant;
2. The full name, address, and telephone number, if known, of the respondent;
3. A concise statement of the facts which the complainant believes constitute a violation of professional ethics and practices; and
4. The full names, addresses, and telephone numbers of any witnesses able to testify as to the facts alleged.
WHEREFORE, complainant requests that the Commissioner of Education investigate this complaint and take such action as is warranted, including the filing of a petition.
Dated this ________ day of ________________, 19____.
_______________________________
(Signature)
(If attorney for complainant, 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 complaint 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 Complainant) .
(Seal)
____________________________
Notary Public
Neb. Admin. Code EDUCATION, DEPARTMENT OF, tit. 92, ch. 28, app A