Level Three Complaint Form

Required

Parent/ Student Complaint Form: Level Three

This form is to be completed and returned to the campus principal or Executive Director of Student Services.

All complaints will be processed in accordance with the district policies FNG (LEGAL) and FNG (LOCAL).

Your Namerequired

First Name

Last Name

Student IDrequired

Your Student's Namerequired

First Name

Last Name

Mailing Address:required

Phone Number:required

Email Address:required

Campusrequired

If you will be represented in voicing your appeal, please identify the person representing you. (1. Name 2. Email Address 3. Address 4. Telephone Number) required

Does the representing party/organization have permission to access records for this appeal?required

To whom did you present your complaint at Level Two?

Date of Level Two Conference? required

Must contain a date in MM/DD/YYYY format

Date you received a response to the Level Two Conference:required

Must contain a date in MM/DD/YYYY format

Please explain specifically how you disagree with the outcome at Level Two. If additional space is needed, you may attach a separate page.required

Attach a copy of your original complaint and any documentation submitted at Level One and a copy of your Level Two appeal notice.required

Attach up to 5 files with a maximum size of 10MB

No file chosen

Attach/upload a copy of the Level Two response being appealed, if applicable.

Attach up to 1 file with a maximum size of 10MB

No file chosen

Student or parent/guardian signature:

Signature of the student's or parent's/guardian's representative:

Date of filing:

Must contain a date in MM/DD/YYYY format