Butler D53 - Curriculum Objection Form

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School *

Subject area *

Classroom teacher *

Please state, as precisely as possible, the specific curriculum area, instructional material, or program to which you object (include name, title, author, and any other identifying information). *

How did you become aware of the curriculum area, instructional material, or program? *

by classroom observation

by review

by word-of-mouth

Other:

Required

To what in the curriculum area, instructional material, or program do you object? Be specific. *

Do you want your child excluded from participation? *

Yes

In place of participation in the curriculum area, what course of study would you recommend for your child? *

Complainant name *

Complainant represents: *

Student

Parent/guardian of student

Other:

Required

Telephone *

Enter a 10 digit phone number without separator or country code. Please note that this is not an update of your information in PowerSchool, it will simply make this information more accessible for this purpose only.

Complainant address *

By checking the box, I provide my electronic signature for the above statements. *

DIGITAL SIGNATURE

Required

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