Level One Complaint Form

Required

Parent/ Student Complaint Form: Level One

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). Attach additional pages if necessary.

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

Please provide a detailed description of the individual, decision, or circumstances that are the basis of yourcomplaint. Include specific factual details. If additional space is needed, you may attach a separate page.required

List the date(s) of the decision or circumstances causing your complaint. required

Please explain how you have been harmed by the decision or circumstances. required

Please describe any efforts you have made to resolve your complaint informally and the response to your efforts. required

With whom did you communicate?

On what date(s)?

Please describe the outcome or remedy you seek for this complaint. required

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

Attach Documentation

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

No file chosen