Name of Person Filing Complaint (Last, First, M.I.) *
Your answer
Phone Number (Include Work Phone Number) *
Your answer
Student's Name and Grade Level *
Your answer
Student ID Number (optional)
Your answer
Name of School Site *
Your answer
Nature of Complaint: *
Describe, in detail, the nature of complaint: *
Your answer
Have you tried to resolve your complaint with your School Administrator(s)? *
If Yes, Who Did You Speak To? (Name, Job Title, Date of Discussion and What Was the Result of the Discussion?) *
Your answer
What Would You Like to Happen As A Result of This Complaint?
Your answer
I understand that a copy of this complaint will be given to the Coordinator of 504 services, and I will receive call/email response within 48 hours in an effort to resolve the complaint. *