Sample Self-certification Form for UCP 5
The Self-certification for UCP 5 form below is a form provided by CDE for the local educational agency (LEA) to complete before its Federal Program Monitoring (FPM) online review declaring the proper implementation of the UCP process, consistent with the Williams Complaints requirements found in 5.0 of the UCP Instrument. The LEA must upload the Self-certification for UCP 5 on the California Accountability and Improvement System (CAIS).
Name of LEA
Address
Phone number
LEA SELF-CERTIFICATION FORM FOR COMPLETION OF AN ONLINE REVIEW OF UCP 5
DATE:
TO: CA Dept of Education, Categorical Programs Complaints Management (CPCM) office
SUBJECT: Evidence of the posting of the Williams Complaints Classroom Notice in every classroom
LEA SELF-CERTIFICATION UCP-5
I certify that a notice has been posted in each classroom in each school in the school district that provides information about filing a Williams-related complaint and meets the requirements as prescribed in the California Education Code, Section 35186(f).
Name of LEA Superintendent or Designee
Signature of LEA Superintendent or Designee
Date
