STUDENT/PARENT COMPLAINT FORM
Schools are very important facilities. They make sure to shape children into huge successes by giving them the proper education they deserve. However, there may be problems within schools that can hinder the educational progress of the students. The person who experienced the problem should normally fill in this form. If you are making a complaint on behalf of someone else please fill in Section B also.
Email address *
What was their response? *
Your answer
When were you made aware of this problem? *
Your answer
If yes, what is your name? *
Your answer
Parent/Guardian information *
Your answer
B. Are you are making the complaint for another person? *
Have you complained to anyone on campus about this issue? If so, who? *
Your answer
What is the name of the school you are complaining about? *
Your answer
Why are you making this complaint for them? *
Your answer
Who did you report this incident to on campus? *
Your answer
Type of complaint *
When did this incident occur? *
MM
/
DD
/
YYYY
What happened to make you contact us? *
Your answer
Does student have an IEP?
Has this type of incident occurred before on campus? *
Do we have your permission to advocate/speak to District Representatives (including Superintendent, Principal, Teachers etc.) on your behalf?
Describe how the incident has affected you. *
Your answer
Full Name of Student *
Your answer
What is your relationship to the complainant? *
Your answer
Contact number *
Your answer
Approximately what time did this incident occur? *
Time
:
What do you think should be done to fix this problem on campus? *
Your answer
How would you prefer us to contact you? *
Grade Level *
A copy of your responses will be emailed to the address you provided.
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