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Student/Parent Appeal Form - Level 2

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

To appeal a Level One decision, or the lack of a timely response after a Level One conference, please fill out this form completely and submit it by hand delivery, electronic communication, or U.S. mail to the Superintendent or designee within the time established in FNG(LOCAL). Appeals 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"

Reason for Appeal

Who held the Level One conference?*

Answer required for "Who held the Level One conference?"

Date of conference:*

Answer required for "Date of conference:"

Date you recieved a response to the Level One conference:*

Answer required for "Date you recieved a response to the Level One conference:"

Please explain specifically how you disagree with the outcome at Level One.*

Answer required for "Please explain specifically how you disagree with the outcome at Level One."

Attach a copy of your original Level One complaint and any documentation submitted at Level One.

Answer required for "Attach a copy of your original Level One complaint and any documentation submitted at Level One."

Choose a file or drag it here.

Attach a copy of the Level One response being appealed, if applicable.

Answer required for "Attach a copy of the Level One response being appealed, if applicable."

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.

Please keep a copy of the completed form and any supporting documentation for your records.

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"