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Student/Parent Complaint Form - Level 1

Please complete the form below. Required fields marked with an asterisk *

To file a formal complaint, please fill out this form completely and submit it by hand delivery, electronic communication, or U.S. mail to the appropriate administrator within the time established in FNG(LOCAL). All complaints will be heard in accordance with FNG(LEGAL) and (LOCAL) or any exceptions outlined therein.

Contact Information

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Telephone*

Number Required

Email address*

Answer required for "Email address"

Representative (If applicable)

If you will be represented in presenting your complaint, please identify the person representing you.

First Name

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name

Answer required for "Last Name"

Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Telephone

Number Required

Email Address

Answer required for "Email Address"

Complaint/Greivance

Please describe the decision or circumstances causing your complaint (give specific factual details).*

Answer required for "Please describe the decision or circumstances causing your complaint (give specific factual details)."

What was the date of the decision or circumstances causing your complaint?*

Answer required for "What was the date of the decision or circumstances causing your complaint?"

Please explain how you have been harmed by this decision or circumstance.*

Answer required for "Please explain how you have been harmed by this decision or circumstance."

Please describe any efforts you have made to resolve your concerns and the responses to your efforts. Please include dates of communication and whom you communicated with regarding your concerns.*

Answer required for "Please describe any efforts you have made to resolve your concerns and the responses to your efforts. Please include dates of communication and whom you communicated with regarding your concerns."

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

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

Attach to this form any documents you believe will support the complaint; if unavailable when you submit this form, they may be presented no later than the Level One conference.

Answer required for "Attach to this form any documents you believe will support the complaint; if unavailable when you submit this form, they may be presented no later than the Level One conference."

Choose a file or drag it here.

Confirmation*

Answer required for "Confirmation"

I hereby certify that all information provided in this form is true, accurate, and complete to the best of my knowledge.

Name of Student/Parent:*

Answer required for "Name of Student/Parent:"

Name of student's or parent's representative:

Answer required for "Name of student's or parent's representative:"

Signature*

Signature Required

Date of filing.

Answer required for "Date of filing."

Complainant, please note:

A complaint form that is incomplete in any material way may be dismissed, but may be refiled with all the required information if the refiling is within the designated for filing a complaint.

Attach to this form any documents you believe will support the complaint; if unavailable when you submit this form, they may be presented no later than the Level One conference. Please keep a copy of the completed form and any supporting documentation for your records.

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"