Complaint Form

Instructions for Preparing a Complaint

NDE Certification Investigations’ Office

  1. If you are filing a Complaint against more than one person, a separate form should be used for each person. If you have more than one complaint against the same person, you should use one form and describe each incident in the third paragraph. As the Complainant, your name and address must appear in the blanks at the top of the first page on the left hand side of the Complaint. Also your name, address, and telephone number should appear in the first paragraph.
  2. The person against whom a Complaint is filed is called the Respondent and the Respondent’s name and address must appear at the top of the first page on the left hand side, below your name. Also list the Respondent’s name, address, and telephone number, if known, in the second paragraph.
  3. In the third paragraph, please list the facts which you believe constitute a violation of professional conduct and ethics. Use additional sheets as necessary and number each page.
  4. In the fourth paragraph, list individually the full name, address, and telephone number of each witness able to testify as to the alleged incident.
  5. Your signature should appear after the fourth paragraph and you should sign the “verification” paragraph and have your signature notarized.
  6. Mail the completed complaint form, through regular United States Mail, to: Certification Investigations’ Office, P.O. Box 94933, Lincoln, NE 68509-4933.
  7. If you have any questions, please contact the Certification Investigations’ Office at
  8. A blank complaint form may be printed and filled out, or you may complete an English-only fillable complaint form which will need to be printed and signed. Detailed instructions for completion of the form are included in 92 NAC 28 (Nebraska Department of Education Rule 28).
Updated April 23, 2019 9:30am