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Self-certification for UCP 3 (for FPM reviews)


Sample Self-certification Form for UCP 3

This Sample Self-certification for UCP 3 is a form below provided by CDE for the local educational agency (LEA) to complete before its Federal Programs Monitoring (FPM) online review declaring either (A) the LEA had no UCP complaints within a 12-month period or (B) the proper implementation of the UCP investigation process, consistent with the requirements of 3.1, 3.2 of the UCP Instrument. The LEA must upload the Self-certification for UCP 3 on California Accountability and Improvement System (CAIS).

LEA SELF-CERTIFICATION FORM FOR COMPLETION OF AN ONLINE REVIEW OF UCP 3

NAME OF LEA:

ADDRESS:

PHONE NUMBER:

DATE:

TO: CA Dept of Education, Categorical Programs Complaints Management (CPCM) office
SUBJECT: Evidence of proper implementation of the investigation process

Please check A or B below:

A. I certify that the LEA has not received any UCP complaints in the past 12 months.

B. If the LEA has received one or more non-Williams-related UCP complaints with in the past 12 months, a random selection of UCP complaints will be chosen after the upload period and prior to the last day of the on-line review. A CPCM consultant will select individual files to be reviewed by the LEA, and these files will be designated a number (i.e. 1, 2, 3, etc.). The consultant will inform the LEA of the files selected and the LEA will finalize the self-certification by completing the following table and uploading it into CAIS:

UCP 3 Instrument Required Elements

LEAs will be asked to answer Yes or No to the following questions regarding the non-Williams-related UCP complaints chosen by the CPCM consultant:


Signed:

Name of LEA Superintendent or Designee Position


Notes:


Questions:   Categorical Programs Complaints Management Office| 916-319-0929
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