Unauthorized Disclosure Complaint Information
Parents, eligible students (students who are at least 18 years of age), principals, teachers, and employees of an educational agency may file a complaint about a possible breach or improper disclosure of student data and/or protected teacher or principal APPR data using this online form. Please do NOT include any information in this form that would constitute student personally identifiable information.
Email *
First Name: *
Last Name: *
Phone Number: (required) *
Please enter in this format: 555-555-5555 or 555-555-5555 x55555
Role/Relationship to Student *
Possible Improper Disclosure or Breach Information: *
Description of Event(s): *
Description of Possible Disclosed Data: *
Description of How Reporter Learned of Possible Disclosure: *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of BHBL. Report Abuse