Concern Form
Complete this form if you believe district rules, procedures, or policies were not followed. Thank you.
The Ithaca School District does not discriminate on the basis of sex, color, race, religion, age, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation or physical, mental, emotional or learning disability.

Name *
Your answer
Email Address (if applicable)
Your answer
Phone *
Your answer
Describe the decision/circumstances as it/they occurred. Be sure to include place, date, time, and names (if possible) *
Your answer
What do you feel would be an acceptable resolution to this problem? *
Your answer
Please provide any additional information/comments that might assist in reaching a resolution
Your answer
Date you filled out this form *
Thank you for taking the time to submit this form, you may not be notified of the results. If you need it in paper form, please contact the Ithaca School District Office.
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