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 *
Who did you report this incident to on campus? *
Your answer
What was their response? *
Your answer
How would you prefer us to contact you? *
Does student have an IEP?
What happened to make you contact us? *
Your answer
B. Are you are making the complaint for another person? *
If yes, what is your name? *
Your answer
Type of complaint *
Grade Level *
Has this type of incident occurred before on campus? *
Approximately what time did this incident occur? *
Time
:
When were you made aware of this problem? *
Your answer
Contact number *
Your answer
Have you complained to anyone on campus about this issue? If so, who? *
Your answer
What do you think should be done to fix this problem on campus? *
Your answer
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
Why are you making this complaint for them? *
Your answer
When did this incident occur? *
MM
/
DD
/
YYYY
What is the name of the school you are complaining about? *
Your answer
Full Name of Student *
Your answer
Parent/Guardian information *
Your answer
What is your relationship to the complainant? *
Your answer
A copy of your responses will be emailed to the address you provided.
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