Discipline Complaint Form

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Students, parents and other guardians, and school staff may file a complaint and seek corrective action when the requirements of the Minnesota Pupil Fair Dismissal Act, including the implementation of the local behavior and discipline policies, are not being implemented appropriately or are being discriminately applied.

This form provides the opportunity for students, parents and other guardians, and school staff to submit a complaint and additional information related to their complaint. The complaint will be investigated by the Student Services Department within three school days of the receipt. The person submitting the complaint will receive a response from the Student Services Department at the conclusion of the investigation.

Lakeville Area Schools prohibits reprisals against any person who asserts, alleges, or reports a complaint.

First Name of person submitting the complaint *

Last Name of person submitting the complaint *

Relationship to the student *

Myself (student)

Parent

Other Guardian

School Staff

Best phone number to contact you at during the work day. *

Email address

Student First Name *

Student Last Name *

School where discipline took place *

Name of school staff(s) implementing discipline you are asking to be investigated. *

Please provide your information about the incident, response and disciplinary actions. *

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This form was created inside of ISD194 Lakeville Area Public Schools.

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