Unauthorized Disclosure of Personally Identifiable Data (PII) Complaint Form
Based on New York State 2-d Law and Part 121 regulations, parents, eligible students who are at least 18 years of age who attend a Rush-Henrietta school, and employees may file a complaint about a possible breach or improper disclosure of student data and/or protected staff data.

Complaint Procedures
• The school district will acknowledge receipt of the complaint within seven business days.

• The school district will commence an investigation and take necessary precautions to protect any personally identifiable information.

• Following its investigation, the school district shall provide the parent or staff member with a report of its findings within 60 calendar days from receipt of the complaint.

In extenuating circumstances, where the district requires additional time to investigate the complaint or cooperate with law enforcement, or where releasing the report may compromise security or impede the investigation of the incident, the district shall provide the parent or eligible student with a written explanation that includes the approximate date when the district anticipates the
report will be released.





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Complainant's First Name *
Complainant's Last Name *
Phone Number *
Email *
Student Name (if applicable)
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