SACS Parent Complaint Form

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Email Address *

Parent's Name *

Phone Number *

Student's Name *

Grade *

Date of Incident *

YYYY

Teacher's Name *

Please briefly describe you concern/need: *

Desired Outcome: (Please briefly describe the outcome or resolution you are seeking) *

Prior communication please check all that apply: *

I have spoken with or had a conference with the appropriate teacher regarding this situation.

I have spoken with or had a conference with an Assistant Principal/ Counselor regarding this situation.

I have not yet spoken with any campus staff member regarding this incident.

Required

I request the following: *

A phone call from the teacher

A phone call from a counselor

A phone call from a campus administrator

A conference with a counselor

A conference with the teacher

A conference with a campus administrator

Required

Submit

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This form was created inside of Southern Avenue Charter School.