PARENT CONCERN FORM

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PARENT CONCERN FORM

John Griffin Middle School encourages students and parents to discuss their concerns and complaints through informal conferences with the appropriate teacher, principal or other campus administrator. In order to better facilitate your concern in a thorough and timely manner, please complete the information below.

Parent's Name

Student's Name *

Grade *

Today's Date *

YYYY

Date of Incident *

Daytime phone number *

Email *

Teacher's/Staff Member Name (if applicable)

Please briefly describe your concern/need: (Please attach any additional documentation if necessary) *

Desired Outcome: (Please briefly describe the outcome or resolution you are seeking)

Prior Communication-please check all that apply: *

I have spoken with or had a conference with the appropriate teacher regarding this situation.

I have spoken with or had a conference with an Assistant Principal/Counselor regarding this situation.

I have not yet spoken with or had a conference with any campus staff member regarding this incident.

Required

I request the following: *

a phone call from the teacher

a phone call from a counselor

a conference with a counselor

a phone call from a campus administrator

a conference with the teacher

a conference with a campus administrator

Other:

Required

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